Factors associated with misdiagnosis of acute stroke in young adults

J Stroke Cerebrovasc Dis. 2011 Nov;20(6):523-7. doi: 10.1016/j.jstrokecerebrovasdis.2010.03.005. Epub 2010 Aug 17.


Misdiagnosis or delayed diagnosis of acute ischemic stroke can result in neurologic worsening or a missed opportunity for thrombolysis. Because stroke in young adults is less common than stroke in the elderly, we sought to determine clinical characteristics associated with misdiagnosis of stroke in young adults. Patients from the prospectively maintained Young Stroke Registry in our comprehensive stroke center were reviewed. Demographic information, past medical history, presentation within the 3-hour time window, and outcomes were assessed. We compared patients misdiagnosed and those correctly diagnosed to identify factors associated with misdiagnosis of acute stroke. A total of 57 patients aged 16-50 were enrolled in the registry during 2001-2006. Eight patients (14%; 4 men and 4 women; mean age, 38 years) were misdiagnosed. Seven of these 8 patients were discharged from the emergency department initially. Patients age <35 years (P = .05) and patients with posterior circulation stroke (P = .006) were more likely to be misdiagnosed. All 8 misdiagnosed patients were initially evaluated at hospitals that were not certified primary stroke centers. Patients presenting with vertebrobasilar territory ischemia have a greater rate of misdiagnosis. Our study demonstrates the increasing need for "young stroke awareness" among emergency department personnel. Initial misdiagnosis can potentially lead to a lost opportunity for thrombolysis in otherwise good candidates.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Attitude of Health Personnel
  • Chi-Square Distribution
  • Clinical Competence
  • Diagnostic Errors*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Michigan
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Registries
  • Risk Assessment
  • Risk Factors
  • Stroke / complications
  • Stroke / diagnosis*
  • Young Adult