Conditions that mimic stroke in elderly patients admitted to the emergency department

Abstract

Background: Stroke is the most common neurologic cause for patient admission to the emergency department (ED) and the risk of stroke increases with age. This study aimed to determine the clinical and demographical characteristics of stroke-mimicking patients 65 years or older who were admitted to the ED for stroke. Methods: After the retrospective file examination, patients 65 years and older who were admitted to the ED with an established final diagnosis of stroke as a result of history, physical examination, imaging, and required consultations were included in the study. Results: After scanning 671 records of patients 65 years or older, 87.3% (n = 586) were diagnosed with stroke and 12.7% (n = 85) received different diagnoses mimicking stroke. Of these 85 patients, 91.8% (n = 78) and 8.2% (n = 7) were prediagnosed with ischemic stroke and transient ischemic attack, respectively, by the ED physicians. After complete evaluations and consultations, the patients with stroke were typically diagnosed with vertebrobasilar insufficiency (n = 16, 18.8%). Of the patients, 76.5% (n = 65) were discharged after treatment and follow-up in the ED, and 21.1% (n = 18) were hospitalized. Conclusions: In older patients, stroke-mimicking conditions can cause signs and symptoms indistinguishable from true stroke, representing about 12.7% of elderly patients admitted to an ED with these diagnoses.