Is this a stroke? The profile of patients with suspected acute cerebrovascular accident transferred by ambulance to the Neurology Emergency Department

Purpose:
Stroke mimics (SMs) are conditions that present similarly to acute cerebrovascular accidents (CVA), potentially leading to diagnostic errors made by physicians or emergency medical teams (EMT). This study aimed to analyse the profile of patients transferred by EMT to the neurological emergency department (NED) with suspected CVA, and to assess the incidence and charac­teristics of SMs.

Methods:
This retrospective study analyzed data from patients admitted to the NED with suspected CVA, transferred by EMT between August 1, 2021 and to January 31, 2022. Data collected included demographic and clinical information obtained both from NED and EMT records.

Results:
During the study period, 281 patients with suspected CVA were admitted to the NED, of which 74 (26.3%) were diagnosed as SMs. The most common SMs were seizures (24.3%) and infections (14.9%). CVA occurrence was significantly associated with central facial palsy, speech disorders, pyramidal signs and arterial hypertension, but confusion and active cancer were more commonly linked to SMs diagnosis. Patients whose emergency medical cards were correctly completed were less likely to be diagnosed with SMs compared to those with at least one missing parameter (36% in the CVA group vs. 21% in the SMs group, p = 0.029).

Conclusions:
Focal neurological signs are indicative of CVA, whereas confusion and a history of active cancer are more commonly associated with SMs. The accuracy and completeness of data collected by EMTs may play a crucial role in the CVA diagnostic process, potentially reducing misdiagnoses of SMs.