What is Stroke-Like Conditions (Stroke)?
Strokes, or cerebrovascular accidents (CVA), are consistently among the top five causes of death globally and the leading cause of disability in the U.S. They usually appear suddenly as a focal neurological deficit, meaning a loss of function related to a specific brain area. There are also non-vascular conditions with similar symptoms, known as stroke mimics, which can confuse diagnosis. Diagnosing a stroke can, therefore, present a real challenge.
It’s a race against time to identify a stroke and distinguish it from stroke mimics. The reason being, the two main treatments available – drug-induced clot dissolving (pharmacologic thrombolysis) and mechanically removing the clot (endovascular thrombectomy) – are bound by strict time frames and are less beneficial if there are delays. This means there’s a huge focus on minimizing the time it takes from when symptoms start to when treatment begins.
This pressure does mean that there’s more likelihood of identifying and treating a stroke mimic as a real stroke, also known as false positives. This is because we have to be more sensitive to the possibility of stroke, but it also means we may lose some accuracy in the diagnostic process. Stroke treatments can also have potential dangerous side effects, such as life-threatening bleeding in the brain, underscoring the importance of distinguishing a real stroke from a stroke mimic.
In short, in today’s world where ‘time equals brain,’ the assessment and treatment of strokes and stroke mimics walk a fine line between timely treatment of true strokes and over-treating of potential stroke mimics.
What Causes Stroke-Like Conditions (Stroke)?
Several medical conditions can cause sudden, localized symptoms affecting the nervous system, which can easily be mistaken as signs of a stroke. These symptoms are often similar to those caused by a stroke, even when observed through brain imaging technologies such as MRI.
Low blood sugar, or hypoglycemia, is a common cause of acute neurologic symptoms. Severe hypoglycemia can appear on an MRI in a similar way to a stroke, as it causes the nerve cells in the brain to not have enough energy, leading to damage. Despite the similarities, one way to distinguish MRI changes due to hypoglycemia from a stroke is to note if the changes occur across different blood-flow territories in the brain. This insight underscores the importance of immediate blood sugar testing in patients presenting with sudden neurological symptoms, which is a quick and cost-effective way to diagnose hypoglycemia.
Seizures are another common cause of acute neurological symptoms that can mimic a stroke. A condition called Todd’s paralysis may occur after a seizure, presenting temporary neurologic symptoms. Further complicating matters, both immediate and long-term strokes can cause seizures, making this mimic very tricky to rule out when diagnosing an acute stroke.
Complex migraines can also cause localized neurological symptoms. Hemiplegic migraines, though rare, can similarly be misdiagnosed as a stroke. Tumors inside the brain or spinal cord can also cause acute neurologic symptoms that may be mistaken for a stroke. These symptoms may arise due to a tumor-triggered seizure, a bleed within the tumor, or compression of blood vessels around the tumor, leading to neurological symptoms within that particular blood vessel’s territory.
Risk Factors and Frequency for Stroke-Like Conditions (Stroke)
Misdiagnosis of CVA, also known as a stroke, is estimated to occur between 5% and 31% of the time. There are several conditions that often get mistaken for strokes. These include disorders like peripheral vertigo, seizures, and primary headaches.
- Misdiagnosis of CVA or stroke happens in 5% to 31% of cases.
- Peripheral vertigo, seizures, and primary headache disorders are often mistaken for strokes.
- Other conditions that can be mistaken for a stroke include intracranial space-occupying lesions, demyelinating disease, movement disorders, sepsis, delirium, metabolic disturbances, hepatic encephalopathy, and functional psychiatric disorders.
Signs and Symptoms of Stroke-Like Conditions (Stroke)
Similar to strokes (CVAs), there are conditions that can mimic their symptoms. These include difficulties with speech, weakness or feeling numb in the arms and legs, and an uneven appearance in the face. There are also some symptoms that are more commonly found in these stroke-like conditions, rather than actual strokes. These include experiencing sensory disturbances known as auras, having hallucinations, or dealing with delusions. The presence of these particular symptoms can help doctors tell the difference between real strokes and these similar conditions.
Testing for Stroke-Like Conditions (Stroke)
If someone shows signs of sudden, focused changes in their brain function, it’s critical to immediately check their blood sugar levels. Low blood sugar can not only imitate the symptoms of a brain stroke but can also worsen symptoms from previous strokes.
Additional lab tests include checking a basic group of body chemicals, complete blood count, heart damage markers, blood clotting tests, and an electrical activity test for the heart. A CT scan, which is a type of X-ray, is typically the first choice to image the brain, largely because it’s fast, non-invasive, and widely available. However, this test has limitations, especially in detecting a stroke during the first two days, with some studies suggesting it can only detect a stroke 12% of the time during this period.
A brain MRI, which uses magnetic fields to create detailed images, is more accurate for diagnosing an ischemic stroke, but it may not always be available, especially in an emergency situation.
Patients’ characteristics can sometimes help us figure out if symptoms might not be a stroke but something that mimics it. People under the age of 50 and those with few or no stroke risk factors like high blood pressure, abnormal heart rhythm, diabetes, or excessive fats in the blood are more likely to have a condition that mimics a stroke rather than an actual stroke. These stroke look-alikes also happen more often in women.
Other details that can help tell a stroke mimic from a real stroke include lack of fatty streaks inside the cranium on a CT angiography, lack of weakness in specific body parts, history of severe headaches, seizure disorders, or prior mental health history.
Treatment Options for Stroke-Like Conditions (Stroke)
For patients showing signs of a stroke, or CVA, and meet certain time-specific criteria, there are two main treatment options: thrombolysis, which is a medication that dissolves blood clots, or endovascular reperfusion therapy, which involves physically removing the clot from the blood vessels. According to research, about 4% of patients given thrombolytics for acute neurological symptoms are later found to have had a stroke mimic, a condition that resembles a stroke but is actually caused by something else.
Interestingly, studies have consistently found that the side effects of giving thrombolytics to patients with stroke mimics are usually less serious than those experienced by patients with a true ischemic CVA, a stroke caused by a clot blocking blood flow to the brain. For example, the risk of symptomatic intracranial hemorrhage, or bleeding within the skull, after taking thrombolytics is much lower in stroke mimic patients (0.5%) compared to those with true ischemic CVA (5.2%).
What else can Stroke-Like Conditions (Stroke) be?
When it comes to determining whether someone has experienced a stroke or something that looks like a stroke (a “stroke mimic”), there’s no one-size-fits-all answer. Stroke mimics, which can include things like metabolic disturbances, intracranial injuries, seizures, and mental health disorders, may present symptoms similar to those of a stroke. Sometimes these symptoms might align with an area in the brain similar to where a stroke might happen. But it’s crucial to remember that this doesn’t always mean a stroke has occurred.
Here are a few hints that might suggest a stroke mimic, rather than a stroke:
- Gradual symptom onset: Stroke symptoms usually happen suddenly. If symptoms develop slowly, it might not be a stroke.
- Positive neurological symptoms: These are symptoms like sudden jerky movements or hallucinations that aren’t typically associated with strokes. Strokes usually cause negative symptoms, like loss of feeling or paralysis.
- Decreased awareness: If a person seems less alert or aware than usual, it could suggest a stroke mimic, like a metabolic encephalopathy (brain disease).
Remember, these are just clues. Strokes and stroke mimics can look very similar, so it’s essential to seek medical help immediately if you notice any potential stroke symptoms.
What to expect with Stroke-Like Conditions (Stroke)
The outcome of stroke-like symptoms largely depends on the root cause, as these symptoms can be brought on by a wide range of diseases. Those experiencing temporary neurological symptoms from conditions like complex migraines or metabolic abnormalities tend to fare better than those suffering neurological symptoms due to conditions like multiple sclerosis, severe infection (sepsis), and advanced liver disease (decompensated cirrhosis).
Possible Complications When Diagnosed with Stroke-Like Conditions (Stroke)
Using thrombolytics, or clot-busting medication, for false strokes has been proven to be generally safe. However, even though it’s pretty safe, this type of treatment is unnecessary and expensive for false strokes. It can add about $5400 to the cost of treatment. Not only that, it can result in longer hospital stays, more tests, and unneeded invasive procedures, which increases the burden on the patient and the healthcare system. Another downside is that there are some rare but serious side effects of these medications, like brain bleeding and allergic reactions, which can cause further health complications.
Key Points:
- Thrombolytics are generally safe for use in false strokes.
- Their use in false strokes is unnecessary and adds to treatment costs.
- This could result in longer hospital stays and more tests or procedures than required.
- Some rare but serious side effects like brain bleeding and allergic reactions can occur.
Preventing Stroke-Like Conditions (Stroke)
There are many campaigns out there that aim to educate the public about early stroke symptoms. The most famous one is the FAST campaign. This campaign uses the acronym FAST (which stands for Face-Arm-Speech-Time) to teach the usual symptoms of a stroke. The campaign also highlights the need to get medical advice as soon as possible.
It’s also crucial that there’s good communication between doctors and patients who were mistakenly diagnosed with a stroke. Patients shouldn’t overlook any neurological symptoms if they happen in the future, as people who were wrongly diagnosed with a stroke could still be at risk of a real ischemic stroke.
