CC BY-NC-ND 4.0 · J Neurosci Rural Pract 2021; 12(03): 550-554
DOI: 10.1055/s-0041-1727419
Original Article

Changing Demographics of Stroke Mimics in Present Day Stroke Code Era: Need of a Streamlined Clinical Assessment for Emergency Physicians

Kaushik Sundar
1  Department of Neurology, Rabindranath International Institute of Cardiac Sciences, Kolkata, West Bengal, India
Ajay Panwar
2  Department of Neurology, Rotary Ambala Cancer and General Hospital, Ambala, Haryana, India
Lomesh Bhirud
3  Department of Neurology, Kiran Hospital, Surat, Gujrat, India
Eldho Mathew Paul
4  Department of Pharmacology, Rajagiri Hospital, Kochi, India
Paul J. Alapatt
5  Department of Neurology, Rajagiri Hospital, Kochi, India
Gigy Varkey Kuruttukulam
5  Department of Neurology, Rajagiri Hospital, Kochi, India
› Author Affiliations
Funding None.


Background There is an apparently high incidence of stroke mimics in the present-day stroke code era. The reason being is the intense pressure to run with time to achieve the “time is brain”-based goals.

Methods The present study was a retrospective analysis of the data collected over a duration of 6 months from April 2019 to September 2019. We observed the incidence of stroke mimics among the patients for whom rapid response stroke code was activated during the study period. We also performed a logistic regression analysis to identify the clinical features which can act as strong predictors of stroke and mimics.

Results A total of 314 stroke codes were activated of which 256 (81.5%) were stroke and 58 (18.5%) were the mimics. Functional disorders and epilepsy were the most common mimics (24.1% each). Female gender (p = 0.04; odds ratio [OR] 2.9[1.0–8.8]), isolated impairment of consciousness (p < 0.01; OR 4.3[1.5–12.6]), and isolated dysarthria (p < 0.001) were the strong independent predictors for a stroke mimic. Hemiparesis was the strong independent predictor for a stroke (p < 0.001; OR 0.0[0.0–0.1]).

Conclusion In the present epoch of rapid response stroke management, a streamlined assessment by the emergency physicians based on the above clinical predictors may help in avoiding the misdiagnosis of a mimic as stroke.

Publication History

Publication Date:
16 June 2021 (online)

© 2021. Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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