Stroke is one of the most common conditions that can affect 1 in 4 people in their lifetime. Most of the time it is due to the blockage of a vessel that leads to the reduced oxygen supply to an area of the brain, while to a lesser extent it is due to the rupture of a vessel and local bleeding that leads to the destruction of an area of the brain. It is one of the most urgent and serious conditions that manifests itself with a multitude of symptoms such as weakness of the upper or lower limb, speech disorders, sensory disturbances, balance and gait disturbances, and even loss of consciousness. The immediate assessment and diagnosis of the stroke is key in its immediate therapeutic treatment in order to save the sensitive brain tissue and reduce the neurological deficits. However, not all cases that appear as strokes are actually strokes. There are conditions that mimic the symptoms of stroke, known as "stroke mimics".
It is important to be aware of these mimetic episodes in order to understand the correct diagnosis and treatment.
What are stroke mimics?
Stroke mimics are conditions or diseases that present with symptoms similar to those of a stroke, but have a different cause. Because of the similar clinical picture, it can be difficult even for doctors to immediately distinguish a true stroke from a mimic without detailed examination and diagnostic tests.
Most Common Mimics of Vascular Stroke
Hypoglycemia/Hyperglycemia: Low or very high blood glucose can cause stroke-like symptoms, such as confusion, weakness, or even loss of consciousness. Usually, these symptoms go away as blood sugar levels return. Several more metabolic disorders can appear as a stroke such as sodium, calcium, kidney or liver function disorder.
Migraine with aura: Migraines with aura often involve the onset of neurological symptoms such as vision problems, numbness and slurred speech, which resemble those of a stroke. The difference is that migraine symptoms often disappear completely after a period of time, without causing permanent damage, and that they recur in a typical way during the patient's lifetime.
Seizures: It is an acute condition due to a simultaneous incorrect discharge of a region or even the whole brain. In some cases, an epileptic seizure, especially after it, can present neurological symptoms such as weakness and paralysis (Todd phenomenon), confusion or even lethargy that mimic a stroke. The differences become more apparent with the passage of time, since these symptoms subside as well as with the analytical taking of the history by a witness to the episode
Infection or inflammation of the brain: Diseases such as encephalitis or meningitis can cause neurological symptoms that mimic a stroke. These infections are usually accompanied by other preceding symptoms such as fever, headache, vomiting as well as a change in the patient's level of communication
Brain tumors: Brain tumors can put pressure on areas that control movement and speech, causing symptoms similar to those of a stroke, such as weakness, problems with speech and balance. Their presentation is likely to be acute, but often careful history taking raises the suspicion of earlier symptoms and can differentiate the two conditions
Multiple sclerosis: is a chronic autoimmune disease that causes damage to the central nervous system, leading to symptoms such as weakness, numbness and difficulty speaking, which can mimic a stroke in the initial phase of its diagnosis
Why is the distinction important?
Distinguishing between a true stroke and a mimic is critical because treatment differs significantly. Ischemic stroke requires immediate medical attention and possibly thrombolytic therapy, which can dissolve the clot blocking blood flow to the brain, and then possibly mechanical thrombectomy, that is, an endovascular attempt to suction out the responsible clot. On the other hand, if someone with a mimic is given thrombolytic therapy it will have no benefit and in some rare cases it is likely to cause serious side effects such as bleeding.
In addition, the correct diagnosis of mimics can lead to the critical correct management of the primary condition in the acute phase. For example, hypoglycemia and hyperglycemia can be immediately life-threatening or even their treatment, while simple and easy, must be fast. Also, epilepsy is a condition that requires special drug treatment in order to stop the wrong synchronous discharge of the brain and prevent a subsequent seizure.
Conclusion
Stroke mimics are not uncommon and present challenges in diagnosis. It is important even for healthcare professionals to carefully evaluate each case, using clinical and diagnostic tests, to ensure the right targeted treatment. Although the symptoms may resemble those of a stroke, proper diagnosis can save lives and prevent serious complications.
It is important to know that any sudden change in motor function, speech or consciousness should be treated as a medical emergency, whether it is a stroke or a mimic. Timely medical advice is the key point in the correct and treatment of any situation.
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