Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit

被引:59
作者
Gargalas, Sergios [1 ]
Weeks, Robert [1 ]
Khan-Bourne, Najma [1 ]
Shotbolt, Paul [2 ]
Simblett, Sara [2 ]
Ashraf, Leah [3 ]
Doyle, Claire [1 ]
Bancroft, Victoria [1 ]
David, Anthony S. [4 ]
机构
[1] Kings Coll Hosp NHS Fdn Trust, Dept Stroke Med, London, England
[2] South London & Maudsley NHS Fdn Trust, Dept Neuropsychiat, London, England
[3] Kings Coll London, Dept Med, London, England
[4] Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England
基金
英国医学研究理事会;
关键词
SYMPTOMS; MOTOR; PHYSIOTHERAPY; REFERRALS; EMERGENCY;
D O I
10.1136/jnnp-2015-311114
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Some patients admitted to acute stroke units are diagnosed as stroke mimics. A minority have a functional neurological disorder (functional mimics'). 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. Methods Patients admitted to the King's College Hospital HASU between 2011 and 2012 were analysed. Data were obtained from the Stroke Improvement National Audit Programme (SINAP) database. Expert consensus diagnosis was used to classify functional mimics. Follow-up information was obtained from a retrospective case series in primary care over the year following discharge. Results 1165 patients were admitted to the HASU; 904 patients with stroke (77.6%), 163 medical mimics (14%) and 98 functional mimics (8.4%). Functional mimics were significantly more likely to be female (63.3%) versus 49.7% medical mimics and 45.5% stroke, and younger (mean age (SD)) 49.1 (18.8) than medical mimic (63.5years (16.7)) and stroke cases (71years (15.5)). Weakness and slurred speech were the commonest presentations of functional mimics and diagnostic MRI was used more often. Clinician recorded visual and speech symptoms and neglect were significantly more frequent in patients with stroke than either mimic group. Of the 68 functional mimics on whom follow-up information was obtained, 40 (59%) were referred to another service most often for a psychologically-based intervention. Conclusions Functional stroke mimics are an important subgroup admitted to acute stroke services and have a distinct demographic and clinical profile. Their outcomes are poorly monitored. Services should be developed to better diagnose and manage these patients.
引用
收藏
页码:2 / 6
页数:5
相关论文
共 18 条
[1]   Neural Correlates of Recall of Life Events in Conversion Disorder [J].
Aybek, Selma ;
Nicholson, Timothy R. ;
Zelaya, Fernando ;
O'Daly, Owen G. ;
Craig, Tom J. ;
David, Anthony S. ;
Kanaan, Richard A. .
JAMA PSYCHIATRY, 2014, 71 (01) :52-60
[2]   Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics [J].
Carson, AJ ;
Ringbauer, B ;
Stone, J ;
McKenzie, L ;
Warlow, C ;
Sharpe, M .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2000, 68 (02) :207-210
[3]   Functional (conversion) neurological symptoms: research since the millennium [J].
Carson, Alan J. ;
Brown, Richard ;
David, Anthony S. ;
Duncan, Roderick ;
Edwards, Mark J. ;
Goldstein, Laura H. ;
Grunewald, Richard ;
Howlett, Stephaine ;
Kanaan, Richard ;
Mellers, John ;
Nicholson, Timothy R. ;
Reuber, M. ;
Schrag, Anette-Eleonore ;
Stone, Jon ;
Voon, Valerie .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2012, 83 (08) :842-850
[4]  
Fitzpatrick M, 2013, BRIT J NEUROSCI NURS, V9, P120, DOI 10.12968/bjnn.2013.9.3.120
[5]   How to identify stroke mimics in patients eligible for intravenous thrombolysis? [J].
Foerster, A. ;
Griebe, M. ;
Wolf, M. E. ;
Szabo, K. ;
Hennerici, M. G. ;
Kern, R. .
JOURNAL OF NEUROLOGY, 2012, 259 (07) :1347-1353
[6]   The differential diagnosis of suspected stroke: a systematic review [J].
Gibson, L. M. ;
Whiteley, W. .
JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH, 2013, 43 (02) :114-118
[7]   PRACTICE POINTER Is it a stroke? [J].
Hankey, Graeme J. ;
Blacker, David J. .
BMJ-BRITISH MEDICAL JOURNAL, 2015, 350
[8]   Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test [J].
Harbison, J ;
Hossain, O ;
Jenkinson, D ;
Davis, J ;
Louw, SJ ;
Ford, GA .
STROKE, 2003, 34 (01) :71-76
[9]   Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study [J].
McCormack, Ruaidhri ;
Moriarty, John ;
Mellers, John D. ;
Shotbolt, Paul ;
Pastena, Rosa ;
Landes, Nadine ;
Goldstein, Laura ;
Fleminger, Simon ;
David, Anthony S. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2014, 85 (08) :893-898
[10]   CT and conventional and diffusion-weighted MR imaging in acute stroke: Study in 691 patients at presentation to the emergency department [J].
Mullins, ME ;
Schaefer, PW ;
Sorensen, AG ;
Halpern, EF ;
Ay, H ;
He, J ;
Koroshetz, WJ ;
Gonzalez, RG .
RADIOLOGY, 2002, 224 (02) :353-360