Presentations with limb weakness and sensory disturbances comprise about 70% of all functional stroke mimics. Brain 2010;133:1526-36. Middle Eastern countries may have higher rates of somatization of emotional distress. Chang J, Teleb M, Yang JP, et al. We present two recent successfully litigated malpractice cases in which patients with cerebrovascular accidents were misdiagnosed as stroke mimics. Additionally, what electrolyte imbalance can mimic stroke? ⢠Speech dysfluency and stroke ⢠Conversion disorder ⢠Psychogenic stuttering Case Report Acute-Onset Stuttering as a Stroke Mimic Jennifer L. Dearborn1*, Cassie Davis2 and John W. Krakauer3 1Department of Neurology, Yale School of Medicine, USA 2Department of Psychiatry, Seattle University of Washington School of Medicine, USA Distinguishing Between Stroke and Mimic at the Bedside. Conversion Disorder. Functional neurologic disorders â a newer and broader term that includes what some people call conversion disorder â feature nervous system (neurological) symptoms that can't be explained by a neurological disease or other medical condition. Mimics resemble or may even be indistinguishable from acute stroke symptoms. Testing and diagnosis usually involves a neurologist, but may include a psychiatrist or other mental health professional. Adult-onset forms of Alexander disease are less common. Aims To determine the incidence of functional stroke mimics admitted to a hyperacute stroke unit (HASU); to compare their clinical characteristics with medical mimics and stroke cases and obtain information about outcomes. For example, the patient may complain of blindness, yet cortical visual evoked potentials are normal. In various studies, the most common stroke mimics include brain tumors (gliomas, meningiomas, and adenomas are the most common ones) (4), toxic or metabolic disorders (such as hypoglycemia, hypercalcemia, hyponatremia, uremia, hepatic encephalopathy, hyperthyroidism, thyroid storm (4-6), infectious disorders (e.g. A minority have a functional neurological disorder (âfunctional mimicsâ). Diagnosing stroke is not always straightforward. A stroke occurs due to a disruption of blood circulation in the brain. Psychogenic stroke mimic and clinical examination helpful signs Psychogenic stroke mimic between all mimics, are a small rate that is increasing over time, data from literature report a variable percentage that reach the 28-30% of all mimics. Conversion disorder can account for up to 40% of stroke mimics.1 Conversion disorder is listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) under a somatoformic disorder group (300.11).2 It is described as a psychological disorder, characterised by somatic symptoms with no physiological abnormalities but with an underlying ⦠A seizure occurs due to a surge of electrical activity in the brain. Emotional stimuli and motor conversion disorder. Mimic diagnoses included migraine (84), first seizure (45), Bell palsy (29), and conversion disorders (18). Conversion disorder. Functional neurological disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. The causes and effects they have on your brain health are different, however. Seizure (28.5%) was the most common diagnosis of stroke mimics followed by conversion disorder (25.7%). 8. Discussion. Functional neurological disorder (FND), also called conversion disorder, is an involuntary change in motor or sensory function, where clinical findings provide evidence of incompatibility or incongruency with other recognized neurological or medical disorders. Stroke mimic, secondary to conversion disorder should be considered in those patients under 50 years of age. Key to identifying conversion disorder as a stroke mimic is an inconsistent exam, where the extent of the impairment is often found to be task dependent. Functional Disorders. The most common stroke mimics include migraines, seizures, Bell palsy, conversion disorder, and syncope. J Stroke Cerebrovasc Dis 2012;21:839-43. 9â11 Between-group differences in demographic characteristics can be found in large studies but cannot differentiate between etiologies at the individual patient level. Download PDF: Sorry, we are unable to provide the full text but you may find it at the following location(s): http://europepmc.org/articles/... (external link) ... and loss of motor control. ⢠Todd's paresis (after epileptic seizure) ⢠Hypoglycaemia ⢠Migrainous aura (with or without headache) ⢠Focal seizures ⢠Ménière's disease or other vestibular disorder ⢠Conversion disorder ⢠Encephalitis. Conversion Disorder. Overview. The table below shows other clinical features suggestive of these stroke mimics. Functional Neurological Disorder rare disease report. Segal J, Lam A, Dubrey SW, Vasileiadis E. BMJ Case Rep, 2012, 30 Nov 2012 Cited by: 0 articles | PMID: 23203184 | PMCID: PMC4543770. We describe a case of repetitive stroke mimic episodes, the ⦠Or a patient may J Stroke Cerebrovasc Dis. 1 Patients with FND may present acutely to the emergency department (ED) with symptoms similar to epileptic ⦠All illness has both psychological and physical dimensions. Lyme Disease. A total of 59 children were evaluated with the PSCP. 10. Demographic statistics may also be of value in separating stroke from mimicking migraine. Postictal paresis/paralysis (Toddâs palsy) after a seizure. What Conditions Mimic the Symptoms of a Stroke? Functional stroke mimics often have an onset with panic, dissociation, or a physiological trigger such as migraine or a physical injury to the limb. Other mimics, which would typically not show abrupt onset with an adequate patient history, include toxic metabolic derangements (eg, hypoglycaemia). Though both FNSD and stroke are common in clinical practice, the prevalence of functional stroke ... conversion disorder, hysteria, somatoform disorder, psychosomatic disorder, neurotic disorder, psychoneurosis, abnormal illness behavior, psychogenic disorder, supratentorial disorder and medically-unexplained symptoms. Psychiatric Conditions May Also Mimic Stroke . While partial seizures and complicated migraine are the most common and important TIA/stroke mimics, on occasion panic attacks, conversion disorder, vertigo, and syncope can also be confused with TIA. Functional disorders are one of the commonest stroke mimics both in acute stroke settings and in transient ischemic attack clinics. Clinical diagnosis by signs and symptoms. There are many conditions that can mimic a stroke: sepsis, syncope, intracranial tumor, conversion, and factitious disorder, Bellâs palsy, or previous facial trauma. FND can be broadly defined as a condition characterized by neurological symptoms that lack internal consistency, are genuine, but not explained by a defined disease process. Stroke mimickers can be subdivided into benign and non-benign mimickers (4). Diagnosis of mimics is arguably as important as the diagnosis of stroke.â Dawson, Cloud, Pereira & Moynihan (2016) This is called a stroke mimic. A past medical history which includes any of these disorders should heighten suspicion of these alternate diagnoses. In patients receiving thrombolytic therapy, the most common stroke mimics include complicated migraine, seizure and conversion disorder. May be within the central nervous system or other systemic events. The table below shows other clinical features suggestive of these stroke mimics. The most common diagnosis in children is complicated migraine, seizures disorders, Bellâs palsy and conversion disorders. 1 Like stroke syndromes, functional motor and sensory deficits are typically lateralized, often as hemiparesis. Occurs in ~ 50% of unselected stroke patients ... May mimic physical signs of neurologic disease. When typical stroke symptoms present as a stroke, but there is no actual stroke, it is called a Stroke Mimic. Electrolyte imbalances are a common culprit for stroke mimicry, particularly hyponatremia, or low sodium in the blood. Among these conversion disorder represent as one of the most common situations faced by neurologists We describe two young female patients with symptoms and signs initially of conversion disorder. Stroke mimic: an interesting case of repetitive conversion disorder. While partial seizures and complicated migraine are the most common and important mimics of TIA or stroke, panic attacks, conversion disorder, vertigo, and syncope occasionally can be confused with TIA. Conversion disorder is a "communication" problem in which the brain and bodyâs nerves are unable to send and receive signals properly. as stroke mimics. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. These physical symptoms cannot be explained by an underlying neurological or medical health condition. Mimics account for 20-25% of suspected stroke presentations, occurring frequently in patients under 50 years-old. There are many conditions that can mimic a stroke: sepsis, syncope, intracranial tumor, conversion, and factitious disorder, Bellâs palsy, or previous facial trauma. An acronym that addresses the most common mimics is HEMI. History and physical examination remain the basics of diagnosing a stroke. Moore, MD, et al. Benign mimics of stroke include migraine, conversion disorder, ⦠The This may seem a startling claim, but on reflection it is uncontroversial. (5) A key differential to distinguish strokes from those disorders that mimic a stroke include the rapidity of onset, which tends to occur with strokes and not with most other mimics. Occasionally, space-occupying lesions can present suddenly if they cause a seizure or bleeding. For example, the patient may complain of blindness, yet cortical visual evoked potentials are normal. Stroke mimics, those in whom another diagnosis was established, accounted for 14%. The mean Onset-to-door time was 136.82 minutes and the mean door-to-imaging time was 32.63 minutes in stroke mimics. Conversion disorder symptoms most commonly look like issues involving your nervous system (brain, spinal cord, or other nerves). These include: Uncontrollable movements. Tunnel vision or blindness. 2, 3 Although rare, some cases present to EDs with symptoms mimicking acute stroke and are diagnosed as conversion disorder. Generally, functional symptoms are more common in women, and a recent meta-analysis confirmed this pattern in FSMs ().Patients with functional stroke are, on average, younger than those with vascular stroke and younger than medical stroke mimics (2, 7), but they are older than patients in neurology clinics with other functional syndromes (). ( 13) Common mimics include acute vestibular neuritis, migraine, seizure, metabolic or toxic encephalopathy, seizure, and conversion disorder. It became apparent, however, that both patients had a posterior circulation stroke. Stroke mimics and chameleons. Voon V, Brezing C, Gallea C, et al. 14. From DSM III. From DSM III. Up to 30% of patients with a suspected stroke in the ED may be experiencing a stroke mimic. Gallmetzer P, Leutmezer F, Serles W, et al. The Functional neurological disorder (FND) is one of the commonest causes of stroke mimic, representing with a reported range of 7â45%,,. But her reflexes are normal, and sensation is lost only in the right arm and right leg â not the usual pattern resulting from a stroke. Conversion disorder ... treatment as a profound stroke mimic with risks of severe and permanent brain damage if not treated rapidly. A woman collapses at home and is brought to a hospital, apparently paralyzed and numb on her right side. âAll things being equal, a 24-year-old female is much ⦠Wilkins SS, Bourke P, Salam A, Akhtar N, DâSouza A, Kamran S, et al.. Functional stroke mimics: incidence and characteristics at a primary stroke center in the Middle East.Psychosom Med. Conversion Disorder (DSM-IV-TR #300.11) Conversion disorder is characterized by the occurrence of certain signs or symptoms that are clearly inconsistent with what is known about anatomy and pathophysiology. Fourteen children were identified as having a stroke and 45 children had stroke mimics. Occurs in ~ 50% of unselected stroke patients ... May mimic physical signs of neurologic disease. Functional neurological disorders are an important subgroup of patients with stroke mimics admitted to stroke unit.Their clinical profile and outcome are poorly known. meningoencephalitis) (6), psychological disorders and migraines, seizures ⦠Functional neurological disorder (FND), also known as conversion disorder, constitutes individuals with neurological symptoms precipitated and/or perpetuated by maladaptive cognitive, affective, behavioral, psychological, and perceptual processes. INTRODUCTION. Identification of Functional Stroke Symptoms. Conclusions: Stroke mimic is frequent and heterogeneous entity that can be difficult to identify. Eligible studies were of empirical data published in English. Stroke mimics such as Todd's paresis or hemiplegic migraine account for between a fifth and a quarter of suspected strokes (depending on the setting in which they are assessed). General Discussion. Manifestation of nonvascular disease with a stroke like clinical picture. J of Stroke & Cerebrovasc Dis 2015; 24: 828-833 ⢠Hand et al. Conversion Disorder. In the pediatric population the incidence of stroke mimic is around 79-93% of all presentations of acute focal brain dysfunction. Neurological presentations are varied and complex. 1 Medical literature reveals that possible intracranial pathologies can be overlooked and misdiagnosed as conversion disorder. Also called functional neurological symptom disorder, learn its causes, symptoms, diagnosis, treatment and more from Cleveland Clinic. Lyme disease is a bacterial infection transmitted through ⦠Conversion disorder is a mental health condition where emotional problems are converted into physical symptoms. Acute stroke and conversion disorders are commonly confused with each other in the ED setting. Most common mimics: seizure, encephalopathy, syncope and migraine. Functional (psychogenic) deficits, such as conversion disorder, can mimic stroke. Underlying psychiatric disease poses one of the most difficult challenges in the clinical diagnosis of acute stroke vs. stroke mimic, as patients may present with acute motor or sensory weakness in the setting of a specific emotional trigger. Huff JS. An acronym that addresses the most common mimics is HEMI. Vertigo. Neurology. Stroke mimics (SM) are non-vascular conditions that present with an acute neurological deficit simulating acute ischemic stroke and represent a significant percentage of all acute stroke hospital admissions. Little is known about the prevalence or clinical characteristics of functional stroke mimics (FSM s). Sepsis and Other Infections. Stroke Mimics Neurological Conditions Cardiovascular Disorders Seizure with Toddâs paralysis Syncope Brain Tumor HTN Encephalopathy Demyelinating disorder (eg MS) Psychiatric Dis orders Myasthenia Gravis Conversion Disorder Bellâs Palsy Malingering Complicated Migraines Facticious Disorder Infectious Conditi ons Inner Ear Conditi ons The Hoover sign can help to distinguish organic from non-organic paresis of ⦠WebMD and Very Well Health both have a list of conditions that may be confused for stroke due to their similar symptoms. What are the functional stroke mimics? stroke groups (68.8%) and mimics (58.3%), respectively. Stroke risk factors include hypertension, diabetes, hyperlipidemia, tobacco abuse, advanced age, atrial fibrillation or prosthetic heart valve, and prior stroke. Here are some of the conditions that are sometimes mistaken for multiple sclerosis: 1. Stroke 2006;37:769-775. 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