Acute Stroke Mimics: Etiological Spectrum and Efficacy of FAST, BE FAST, and the ROSIER Scores

S. Aaron, Prabhakar A. T., V. Mathew, L. Jeyaseelan, Kenneth Benjamin, K. Abhilash, Shaikh Atif Iqbal Ahmed, A. Nair
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Abstract

Background and Purpose: Stroke mimics constitute a good number of patients referred as acute strokes within the window period for acute therapies. Proper triaging can avoid unnecessary imaging and even thrombolytic therapies in these patients. This study looked at the etiological spectrum of acute stroke mimics presenting within the 4.5 hours therapeutic window. We also evaluated the FAST, BE FAST, and the ROSIER tools in picking true strokes. Methods: Prospective study conducted over a 2-year period. Results: Acute stroke mimics constituted 328/1635 (20%) of referrals for acute stroke after screening by the neurology stroke team. Focal and generalized seizures with transient weakness and peripheral vertigo were the commonest acute stroke mimics; followed by metabolic causes and psychiatric disorders. Females were more in the stroke mimic group (P = .02). Ischemic heart disease and atherosclerotic risk factors (except diabetes mellitus) were significantly higher among true strokes. In total, 4 (1.2%) of the stroke mimics were treated with IV thrombolysis. Diagnostic accuracy for different stroke differentiating tools are as follows: FAST (sensitivity 85.9%, specificity 52.8%, odds 6.8), BE FAST (sensitivity 97.0%, specificity 31.4%, odds 14.9), and ROSIER scale (sensitivity 85.7%, specificity 59.4%, odds 8.7%). Conclusions: Acute stroke mimics can constitute up to 20% of cases evaluated as acute strokes by neurology stroke teams. None of the triaging tools appear to have enough accuracy. A proper history and clinical examination should be given priority over fixed protocols whenever acute stroke mimic are suspected especially before administering acute costly interventions. Auditing stroke mimics is important to improve acute stroke pathways.
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急性脑卒中模拟:FAST、BE FAST和ROSIER评分的病因谱和疗效
背景和目的:在急性治疗的窗口期,卒中模拟患者构成了大量的急性卒中患者。适当的分诊可以避免不必要的影像学检查,甚至对这些患者进行溶栓治疗。这项研究观察了在4.5小时治疗窗口内出现的急性卒中模拟的病因谱。我们还评估了FAST, BE FAST和ROSIER工具在选择真实笔画方面的效果。方法:前瞻性研究,为期2年。结果:经神经卒中小组筛选,急性卒中模拟患者占转诊急性卒中患者的328/1635(20%)。局灶性和全身性发作伴短暂性虚弱和周围性眩晕是最常见的急性卒中模拟;其次是代谢原因和精神疾病。卒中模拟组女性患者较多(P = 0.02)。缺血性心脏病和动脉粥样硬化的危险因素(糖尿病除外)在真正的中风中显著升高。总共有4例(1.2%)脑卒中模拟患者接受静脉溶栓治疗。不同脑卒中鉴别工具的诊断准确性如下:FAST(敏感性85.9%,特异性52.8%,比值6.8)、BE FAST(敏感性97.0%,特异性31.4%,比值14.9)和ROSIER量表(敏感性85.7%,特异性59.4%,比值8.7%)。结论:急性中风模拟可以构成高达20%的病例评估急性中风由神经卒中团队。所有的分类工具似乎都没有足够的准确性。当怀疑急性卒中模拟时,特别是在实施昂贵的急性干预措施之前,应优先考虑适当的病史和临床检查,而不是固定的方案。听析卒中模拟对改善急性卒中通路非常重要。
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