International Medical Journal, Vol. 20., Iss. 3, 2014, P. 21−25.
Clinical mimicry of acute ischemic cerebrovascular accidents of ischemic type
Ukrainian Medical Dentistry Academy, Poltava, Ukraine
Despite the routine use of neuroimaging in modern clinical practice, the rate of acute ischemic cerebrovascular accidents mimicry ranges from 10 to 50 %. The rate and nosological structure of pathological conditions that mimic transient ischemic attacks and ischemic strokes was investigated, as well as the key clinical signs distinguishing these conditions from the real cerebrovascular accidents. Clinical mimicry of transient ischemic attacks was recorded in 25.3 % cases and imitators of ischemic stroke in 8.0 % cases. Transient ischemic attacks clinical mimicry occurred predominantly due to lipothymia (16.8 %) and peripheral vestibular system disorders (22.2 %). The most common stroke−like conditions were vestibular neuronitis (14.1 %), conversion disorder (11.9 %) and brain tumors (10.2 %). Common features that distinguish stroke−like conditions from real transient ischemic attacks and strokes were younger age, significantly lower rate of co−morbid cerebrovascular risk factors (coronary artery disease, diabetes mellitus, arterial hypertension), high rate of non−specific complaints on admission (loss of consciousness, headache), high probability of absence of focal neurological signs, as well as a significant probability of cognitive impairments. Thus, the knowledge of transient ischemic attacks and stroke mimicry is quite important in the clinical diagnosis of suspected transient ischemic attacks and ischemic stroke, and may be useful for prompt diagnosis.
Key words: ischemic stroke, transient ischemic attack, clinical mimicry.