On the contrary, stereotypical biases based on sex, age, or social background are typical pitfalls for misdiagnosis. 9–11 Between-group differences in demographic characteristics can be found in large studies but cannot differentiate between etiologies at the individual patient level.
1 Like stroke syndromes, functional motor and sensory deficits are typically lateralized, often as hemiparesis. Presentations with limb weakness and sensory disturbances comprise about 70% of all functional stroke mimics. 8 As the utility of examination techniques and clinical signs to identify functional weakness, numbness, and speech disorders are increasingly established, it is now timely to provide a state-of-the-art review, tailored to the needs of the clinician working in acute stroke care.įunctional Limb Weakness and Sensory Deficits
Functional disorder manual#
However, the diagnostic criteria for functional neurological disorder have fundamentally changed with the last revision of the Diagnostic and Statistical Manual of Mental Disorders, replacing what was a principle of exclusion with a phenotype-based diagnosis supported by specific clinical signs that demonstrate inconsistency, reversibility, and top-down modulation of symptoms. 6, 7 Functional stroke mimics are often considered elusive, since they have traditionally been seen as diagnoses of exclusion, characterized by psychiatric comorbidities such as anxiety, neuroticism, or traumatization. 1 Two recent studies from large centers in London, United Kingdom, and Doha, Qatar, demonstrate rates of functional stroke mimics of 8%. 3–5 This problem will not be overcome by optimizing clinical pathways or emerging technologies but by focusing on clinical skills.Ī common type of stroke mimic is functional neurological disorder presenting with limb weakness, numbness, or speech disturbances (previously known as psychogenic or conversion disorder). As strategies to reduce the door-to-needle time are being implemented, the rate of thrombolysis of stroke mimics has increased noticeably. 2, 3 Considering the safety of thrombolysis in stroke mimics (complication rate: 1.5%) 3 and its potential benefit in acute ischemic stroke, it seems permissible to err on the side of overtreatment. 1 In large registries, among patients who are treated with intravenous thrombolysis, the upward-trending rate of misdiagnosis is 3.5% to 4.1%.
The hyperacute clinical diagnosis of stroke remains a major challenge, as 1 in 4 suspected cases turns out to be a stroke mimic.
0 kommentar(er)
