Stroke Mimics. Atlantic Canada Stroke Conference. Dr Warren Fieldus FRCP

Transcription

1 Stroke Mimics Atlantic Canada Stroke Conference Dr Warren Fieldus FRCP

2 No Conflicts of Interest

3 the plan stroke or no stroke QEII Acute Stroke Protocol things to do before the CT common stroke mimics (25 %)

4 Stroke or No Stroke

5 Acute Stroke source of mortality and morbidity rapid treatment available

6 QEII Acute Stroke Protocol

7 Diagnosis of Stroke

8 Things to do before the CT??? stroke mimics account for approx 25% of suspected presentations brain imaging is not the simple answer standard for Dx of stroke can only be clinical history and examination supported by brain imaging (which may be normal)

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10 Case 1 53 y/o M complaining of R sided facial droop PMHx: nil Meds: nil Allergies: nil VS: 65 bpm 120/80 RR 16 98% r/a

11 Bells Palsy vs Stroke Lower Upper

12 Bell s Palsy dysfunction of CN VII facial nerve eyelid drooping, change in taste, pain around ear, increased sensitivity to sound?viral infection causing swelling Tx: prednisone +/- acyclovir

13 Case 2 37 y/o F found confused and slurred speech outside MacDonalds PMHx:? Meds:? Allergies:?

14 Case 2 Paramedics are called and note,,, Tx 1 amp D50W and symptoms resolved

15 Hypoglycemia MC presents with autonomic symptoms but can have focal neurological symptoms ABC DEFG.

16 Case 3 32 y/o F found by roommate ALOC and not moving her L arm and leg VS: 95 bpm 120/80 RR 20 98% r/a BG 7.7 mmol/dl PMHx:? Meds:? BCP Allergies:?

17 Case 3 32 y/o F found by roommate ALOC and unable to move L arm and leg tongue abrasions incontinence

18 Case 3 check her medical records and indicates PMHx : Epilepsy pt admits to being noncompliant with Rx BW: nontherapeutic dilantin level

19 Todd s Paralysis post-ictal paresis usually affects appendages depends on area of brain causing seizure but may cause sensory, motor or visual defects usually spontaneous recovery seizure can also be caused by acute stroke Robert Bentley Todd

20 Case 4 39y/o F c/o 3d of headache and visual field deficit VS: 110 bpm 135/85 RR 16 98% r/a PMHx: appendectomy Meds: nil Allergies: sulfa

21 Migraine Headache approx 30% of ischemic strokes have h/a primary h/a disorders - 10% of stroke mimics tend to be younger, female (70%) Complex Migraine weakness, tingling, blindness, confusion, slurred speech Hemiplegic Migraine Headaches

22 Case 5 45 y/o F c/o severe headache found altered & vomiting on the couch VS: 45 bpm 210/105 RR 20 98% NRB PMHx:? Meds:? Allergies:?

23 Subarachnoid Hemorrhage

24 Intracerebral Hemorrhage

25 Case 6 80 y/o M c/o difficulty walking, leg weakness causing falls just not himself VS: 85 bpm 140/85 RR mmol/dl PMHx: HTN, DM Meds: metformin, ramipril, ASA Allergies: NKDA

26 SubDural Hematoma

27 Case 7 16 y/o M c/o difficulty drinking water, leaking out corner of his mouth VS: 60 bpm 120/80 RR mmol/dl PMHx: nil Meds: nil Allergies: Penicillin

28 Case 7

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30 Lyme Disease bacteria Borellia burgdorferi transmitted via bite from black legged deer tick must be attached 36-48h to transmit Lyme 3 Stages 1. flu like symptoms, joint pains, rash 2. weakness/numbness, heart palpitations, facial paralysis 3. Fatigue, headaches, sleep disturbances, mental confusion

31 Case 8 67 y/o M c/o chest pain, headache and L arm weakness VS: 115 bpm 180/100 RR mmol/dl PMHx: HTN, smoker Meds: HCTZ, ramipril Allergies: NKDA

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35 Transient Ischemic Attack Acute chance to intervene and prevent progression to an acute stroke DAPT & carotid dopplers, ECG

36 CNS Masses typically cause slowly progressive deficits acute deficits may be due to hemorrhage or edema, compression or seizure

37 Functional Disorders frequently a trigger panic attack, dissociative key finding is inconsistency in physical findings and often multiple non uniting complaints often comorbid psychiatric disorders

38 Medications/Tox/Lytes Gabapentin, Gravol, intoxication, hyperkalemic periodic paralysis, Transient global amnesia, tick paralysis.

39 What about Vertigo, Delirium, Syncope

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41 Things to do before the CT stroke mimics account for approx 25% of suspected presentations Do the CT but also... ABC DEFG GOOD Hx/Px PMHx standard for Dx of stroke can only be clinical history and examination supported by brain imaging (which may be normal)

42 QEII on St Patrick s Day