Diagnostic challenge—is this really a stroke?

Ching Luen Ng
Australian Family Physician 2006, 35 (10): 805-8

BACKGROUND: Although acute stroke most commonly presents with hemiparesis, facial weakness and dysphasia, these symptoms can sometimes be the atypical presentations of other conditions which may be difficult to diagnose.

OBJECTIVE: This article presents three cases of stroke mimics and discusses how to improve accuracy in diagnosing stroke in the primary care setting.

DISCUSSION: Stroke is a medical emergency and urgent hospital transfer is vital. Hypoglycaemia, hyperglycaemia, epilepsy, multiple sclerosis, hemiplegic migraine, intracranial tumours or infection (meningitis/encephalitis/abscess) can all mimic stroke. The Los Angeles Prehospital Stroke Screen (LAPSS) consists of four history items, a blood glucose measure, and three examination items designed to detect unilateral motor weakness. It can be utilised to improve the accuracy in diagnosing stroke and stroke mimics in general practice.

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