Stroke Mimics：report of 3 Cases and Review of Literature
- VernacularTitle: 类卒中：3例分析及文献回顾
- Author:
Yaping WU
1
;
Yizhi ZHANG
1
;
Shanji NAN
1
Author Information
- Publication Type:Journal Article
- Keywords: Stroke mimics; Intracranial subdural empyema; Spinal Epidural Hematoma; Todd’s Paralysis
- From: Journal of Apoplexy and Nervous Diseases 2021;38(7):613-616
- CountryChina
- Language:Chinese
- Abstract: Objective In order to improve the clinicians’ awareness of stroke mimics and to avoid inappropriate therapy，we described the clinical data of 3 patients with stroke mimics and reviewed the literature.Methods We retrospectively gave a description of the medical history，clinical manifestations，imaging data and treatments of three typical cases of stroke mimics from January 2017 to September 2018 in our hospital.Results Case1 The patient complained of inability to speak in the morning and weakness of the right limbs for several hours. Head CT showed old lacunar infarctions.The primary diagnosis was acute ischemic stroke（AIS）. The patient developed with fever and seizures during the following days. The diagnosis of intracranial subdural empyema was confirmed by head MRI and further surgery was performed. The reason why we didn’t make the right diagnosis was that the resident didn’t ask the medical history in detail and we didn’t check the head MRI in time.Case 2 We describe a 70-year-old man who presented to our emergency department（ED）with acute onset of left arm soreness and left leg weakness for 5 hours. The AIS was considered. The patient was admitted to the ward and we knew his first symptom was back pain which lasted about few minutes. Spinal cord MRI revealed spinal epidural hematoma. Acute spinal epidural hematoma rarely presents with unilateral weakness of the limbs，mimicking a stroke. Because inappropriate thrombolysis can lead to devastating symptoms，spinal epidural hematoma should be excluded when evaluating an acute stroke patient with a symptom of pain who is a possible candidate for thrombolytic therapy. Case3 The patient admitted to the ward with a seizure，speech disorder and right limbs paralysis for more than 20 hours. The patient’s head MR angiography showed severe stenosis of the left middle cerebral artery. The diagnosis of AIS was made. But the two head MRI being negative for acute ischemic lesion and three dimensional arterial spin-labeled brain perfusion MRI was normal. The diagnosis of AIS was wavering. Within 5 days from the admission，there was almost a complete remission of the neurological findings. The electroencephalogram examination revealed focal abnormalities and Todd’s paralysis was finally confirmed. The neurological deficits during the postictal seizure phase are usually short lasting，but they may last up to days after the convulsion.Conclusion Stroke mimics term is applied in a clinical evaluation，describing those non-vascular conditions that simulate stroke，namely those presenting with an acute neurological deficit.Careful clinical assessment （clinical history and neurological examination）in association with laboratory evaluation is important for depicting the stroke mimics. Brain imaging is essential for the correct diagnosis of AIS and stroke mimic exclusion. With the use of the clinical，laboratory data and magnetic resonance imaging （MRI） evaluation，the misdiagnosis incidence of stroke mimics will decline to lower degree.
- Full text:202407292123348608类卒中_3例分析及文献回顾.pdf
