Avoiding ERrors - July 9, 2016 - By Jesse
"The diagnosis of stroke remains a challenge, due to overlapping symptoms with other conditions, limitations in diagnostic tests, and lack of awareness of posterior circulation presentation and workup. Below is a brief overview of the rate and risk factors for missed stroke, common stroke mimics and chamelons, and the challenge of diagnosing stroke in patients presenting with dizziness.
MISSED STROKE: RATE AND RISK FACTORS
From the Canadian Medical Protective Association’s review, “the biggest issue identified in a review of the CMPA’s medical-legal cases involving stroke was diagnosis…While hemorrhagic strokes make up only 10–15% of strokes overall in the clinical arena,1 close to half of the CMPA cases involved this type of stroke…The common symptoms were headache, dizziness, and nausea and vomiting…Anchoring on a specific diagnosis — most often migraine or psychiatric disorders, but also gastrointestinal, sinus, or musculoskeletal issues — often impeded the final diagnosis of stroke...
In summary, be on guard for stroke mimics and chamelons (especially with altered mental status and dizziness), consider the limitation of CT (especially for posterior circulation stroke), carefully perform and document a full neurological exam (including cranial nerves, HINTS exam, cerebellar tests and gait), and consult neurology if there are any high risk features or concerns."