To understand the spectrum and key imaging findings of stroke mimics.
To review the less common causes and associated imaging findings of ischaemic and haemorrhagic cerebral infarction.
Stroke is a syndrome characterised by the acute onset of irreversible neurological deficit and may be ischaemic and/or haemorrhagic.
Due to the time critical nature of stroke treatment,
there is emphasis on rapid assessment and management of patients. Cerebrovascular imaging plays a crucial role in guiding treatment in the acute clinical setting.
Stroke mimics are conditions that have a stroke like presentation,
accounting for up to 30% of emergency department presentations,
where the provisional diagnosis was stroke.1-4
toxic metabolic pathologies;
Imaging findings OR Procedure details
Part A – Stroke mimics
TOXIC METABOLIC PATHOLOGIES
Multiple toxic and metabolic abnormalities may mimic stroke including MELAS,
abnormal glucose levels,
Wernicke’s encephalopathy and hepatic encephalopathy.
Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke Like Episodes (MELAS)
Mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes is a disorder cause by mutations in mitochondrial DNA.
Manifestations of the disease occur in childhood or early adulthood.
Hallmarks are lactic acidosis and stroke like episodes with hemiparesis and/or cortical blindness.
Other clinical features include...
Imaging is a vital tool in the assessment of patients presenting with stroke.
It is essential that radiologists are familiar with the spectrum of imaging findings of stroke mimics and less common causes of stroke,
to prevent delayed diagnosis and to facilitate appropriate management.
Distinguishing between stroke and mimic at the bedside: the brain attack study.
Stroke 2006; 37: 769-775
Hemanth Rao T.
Conditions that mimic stroke in the emergency department.
Arch Neurology 1995; 52: 1119-1122
Benson RT et al.
Predictors of acute stroke mimics in 8187 patients referred to a stroke service.
J Stroke Cerebrovasc Dis 2013 Nov; 22(8): e397-403