Is it recurrent stroke or a stroke mimic?

Takeaway

• Among survivors of ischaemic stroke or transient ischaemic attack (TIA), the subsequent rate of stroke mimics was 73% higher than that of recurrent stroke during follow-up, with the former most common in the first several months.

Why this matters

• Better understanding of stroke mimics and their pattern of occurrence may aid diagnosis.

Key results

• During a mean 5.6-year follow-up, 18.1% of survivors had a stroke mimic event.
• Cumulative rates:
  • Stroke mimic: 58.7 per 1000 person-years.
  • Recurrent stroke: 34.0 per 1000 person-years.
• Risks for both highest in first year after stroke/TIA.
• Stroke mimic diagnoses:
  • Sequelae of cerebral infarction (19.8%).
  • Medical observation/evaluation for suspected cerebrovascular disease (15.6%).
  • Infection (14.0%).
  • Seizure (9.6%).
  • Dizziness and vertigo (8.3%).
  • Migraine and other headaches (7.7%).
  • Syncope and collapse (7.1%).
• Sequelae of cerebral infarction and medical observation/evaluation clustered in first 3 months after stroke/TIA.

Study design

• Norwegian single-centre hospital-based prospective cohort study of 1872 adult survivors of ischemic stroke or TIA diagnosed during 2007-2013.
• Main outcomes: recurrent strokes and stroke mimics ascertained by admission with diagnostic workup.
• Funding: None disclosed.

Limitations

• Possible underestimation of events.
• Unknown generalisability.