Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone...

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Published in:Neuropsychiatric disease and treatment 2021-01, Vol.17, p.1469-1480
Main Authors: Wallace, Emma J C, Liberman, Ava L
Format: Article
Language:English
Subjects:
Ambulatory medical care
Cerebrovascular disease
Cerebrovascular diseases
Consciousness
Diagnosis
diagnostic error
Diagnostic errors
Fainting
Hypertension
Ischemia
Medical diagnosis
Medical errors
Medical malpractice
Mental disorders
Methods
Morbidity
Mortality
Patients
Prevention
Review
Risk factors
Stroke
Stroke (Disease)
stroke chameleons
Transient ischemic attack
Veins & arteries
Vertigo
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description Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone to missed or delayed diagnosis. We therefore detail common stroke chameleon symptoms as well as atypical stroke presentations, broadly review new developments in the study of diagnostic error in the outpatient setting, suggest practical clinical strategies for diagnostic error reduction, and emphasize the need for rapid consultation of stroke specialists when appropriate. We also address the role of psychiatric disease and vascular risk factors in the diagnostic evaluation and treatment of suspected stroke/TIA patients. We advocate incorporating diagnostic time-outs into clinical practice to assure that the diagnosis of TIA or stroke is considered in all relevant patient encounters after a detailed history and examination are conducted in the outpatient setting.
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source Taylor & Francis Open Access; Publicly Available Content (ProQuest); PubMed Central
subjects Ambulatory medical care
Cerebrovascular disease
Cerebrovascular diseases
Consciousness
Diagnosis
diagnostic error
Diagnostic errors
Fainting
Hypertension
Ischemia
Medical diagnosis
Medical errors
Medical malpractice
Mental disorders
Methods
Morbidity
Mortality
Patients
Prevention
Review
Risk factors
Stroke
Stroke (Disease)
stroke chameleons
Transient ischemic attack
Veins & arteries
Vertigo
title Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes
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