Stroke-Like Conditions

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
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Excerpt

Cerebrovascular accidents (CVA) consistently rank within the top five causes of death worldwide and are the number one cause of disability in the United States. Ischemic CVAs typically present with the sudden onset of a focal neurological deficit in a vascular distribution, and many non-vascular conditions, called stroke mimics, can present with similar symptoms, presenting a diagnostic conundrum. The diagnosis of CVA and its differentiation from potential stroke mimics is extremely time-sensitive: the two available treatments in ischemic CVA, pharmacologic thrombolysis and endovascular thrombectomy, are limited by strict timing criteria and contraindications, and the benefit of both these treatments decreases with delays in treatment initiation. This focus on minimizing the time from symptom onset to treatment initiation makes the differentiation between true CVAs and stroke mimics challenging. Because of the time-sensitive nature of CVA diagnosis and the recent emphasis on metrics such as "door-to-needle time," a high level of sensitivity for CVA diagnosis is necessary, though this necessarily leads to decreased specificity in the diagnostic evaluation and therefore an increased number of stroke mimics being evaluated and treated as true ischemic strokes. The treatment for CVA is associated with potentially harmful side effects, including life-threatening intracranial hemorrhage, highlighting the importance of distinguishing a true ischemic CVA from a potential stroke mimic. Thus, in this era of "time equals brain," the evaluation and treatment of strokes and stroke mimics walk a fine line between timely treatment initiation in CVAs and overtreatment of stroke mimics.

Publication types

  • Study Guide