We thank Dr Benbadis for his interest in our study1 on conditions that mimic stroke in the emergency department. In our article, focal deficits may or may not have been present at the time the diagnosis of stroke was made, but would then have been suggested by the history. In these cases, if an attending neurologist's or emergency physician's note documented stroke as the leading diagnosis, then the patient was included in the study. An example might be the case of a patient with angina or even myocardial infarction in whom the primary symptom was numbness affecting the left arm and perhaps jaw, with chest pain being less significant or even absent. Four such cases mimicked stroke in our study. In addition, miscellaneous metabolic disturbances can cause focal symptoms or signs2 and even isolated vertigo is not always easily characterized as peripheral as opposed to central.
Libman RB, Wirkowski E. Conditions That Mimic Stroke-Reply. Arch Neurol. 1996;53(5):404. doi:10.1001/archneur.1996.00550050026011