Neurological examination, rather than vascular risk factor assessment, serves to distinguish strokes from stroke mimics.

Abstract Purpose Stroke mimics takes upto 30% of patients presenting with stroke-like symptoms. We aim to evaluate the stroke mimic rate and to identify factors that may differentiate stroke mimics from real strokes in a population with a high prevalence of vascular risk factors. Materials and Methods From January 1st to December 31st 2013, patients who had Stroke Alert activations were retrospectively reviewed. Stroke mimics were defined as patients who had Stroke Alert activation, but the discharge ICD-9 codes did not include the diagnosis of ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Demographics, clinical history, laboratory data, neurologic examinations, Acute Stroke Scales were analyzed in univariate and multiple logistic regression analyses. Results In 368 Stroke Alert activations, 184 (50%) were stroke mimics. Common causes of strokes mimics were seizure disorders (11.4%), and other malaise and fatigue (4.9%). 93% of patients for whom a Stroke Alert was activated had at least one vascular risk factor. Univariate analysis found that seizure history, seizure at onset, negative findings on neurological exam, and lower scores on three different stroke scales/screen were associated with stroke mimic. Multiple logistic regression analysis showed that normal visual fields, lack of unilateral arm weakness, seizure at onset, lack of lateralizing symptoms, no exact onset, and lower glucose levels were independent predictors of stroke mimics. Conclusion Assessment of vascular risk factors is not useful for differentiating between stroke and mimic in our population. Attention to seizure history and a thorough neurological examination can assist in identifying stroke mimics.