Zusammenfassung
Durch die Einführung zeitkritischer Therapieoptionen beim ischämischen Schlaganfall
und dem damit verbundenen Druck zum schnellen Handeln
erhöht sich die Wahrscheinlichkeit von diagnostischen Fehleinschätzungen (Stroke Mimics
und Stroke Chamäelons). Dieser Beitrag erklärt
dieses Begriffspaar und seine Charakteristika in den unterschiedlichen Behandlungsphasen
und zeigt die Möglichkeiten zur Reduzierung der
Rate der Fehldiagnosen auf.
Abstract
The analysis of misdiagnosis of stroke has become increasingly relevant because of
the time pressure in the thrombolytic treatment of ischemic strokes. Within the narrow
time window of thrombolysis, a false-positive stroke diagnosis can lead to a faulty
and potentially dangerous thrombolysis. The terms “Stroke Mimic” (SM = false-positive
stroke diagnosis) and “Stroke Chameleon” (SC = false-negative stroke diagnosis) have
been introduced for misdiagnosis in this field. The rate of SM decreases during the
treatment phases from approximately 50 % in the preclinical situation to approximately
2–10 % in the Stroke Unit indicating thrombolytic therapy. The complication rate for
not indicated thrombolysis in SM is low with 0.5 % for intracranial bleeding and 0.3 %
for orolingual edema. Thus, the net balance in favour of fast thrombolysis is maintained,
even when a higher number of mis-indicated lyses occurs in SM. The rate of SC during
the stages of treatment drops from about 50 % in the preclinical stage to about 2–5 %
in stroke units. The rates of SM and SC are inversely linked: a reduction in the SM
rate leads to a more critical diagnosis of stroke, thus increasing the number of underdiagnosed
stroke cases as SC, and vice versa. While SM rarely lead to the legal consequences
of treatment error, SC often give rise to accusations of medical errors.
Schlüsselwörter
Stroke Mimics - Stroke Chamäleons - Schlaganfall-Fehldiagnosen - Schlaganfall-Differenzialdiagnosen
Key words
Stroke chameleons - stroke misdiagnosis - Stroke mimics - stroke differential diagnosis
