The differential diagnosis of suspected stroke: a systematic review

J R Coll Physicians Edinb. 2013;43(2):114-8. doi: 10.4997/JRCPE.2013.205.


Background: We aimed to determine the proportion of patients who had suffered a stroke and compare this to those patients with suspected stroke, and the range of differential diagnosis for suspected stroke.

Methods: We searched for prospective studies of suspected stroke in electronic databases and our personal files. We undertook a meta-analysis of these studies, aimed at determining the proportions of patients with confirmed stroke in different settings.

Results: We identified 29 studies involving 8,839 patients: 13 studies were from emergency departments, five from stroke units or transient ischaemic attack (TIA) clinics, three from primary care, three from ambulance services and five were unspecified. About three-quarters (74% [95% confidence interval (CI): 66 to 83%]) of patients had a diagnosis of stroke, though there was significant heterogeneity in this estimate. The five most frequent non-stroke diagnoses were seizure, syncope, sepsis, migraine and brain tumours.

Conclusion: Patients who had not had a stroke accounted for a significant proportion of people referred to stroke services. Expertise in the differential diagnoses of stroke is needed in order to manage the patients at the point of referral.

Keywords: Stroke; diagnosis; epidemiology; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Clinical Competence*
  • Diagnosis, Differential
  • Health Facilities*
  • Health Services Needs and Demand
  • Humans
  • Primary Health Care*
  • Referral and Consultation*
  • Stroke / diagnosis*