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May 1996

Conditions That Mimic Stroke

Author Affiliations

Department of Neurology Medical College of Wisconsin Comprehensive Epilepsy Program 9200 W Wisconsin Ave Milwaukee, WI 53226

Arch Neurol. 1996;53(5):404. doi:10.1001/archneur.1996.00550050026010

The recent article by Libman et al1 has crucial implications for acute stroke management. For the clinician, knowing which conditions may mimic stroke is indeed very important information. However, knowing how these conditions may mimic stroke may be equally important. The inclusion criterion in their "Patients and Methods" section stated: "sudden onset of a focal deficit—either by history or on examination" is somewhat vague and perhaps overly inclusive. The focal deficits on the basis of which these conditions were misdiagnosed as strokes could have been prevented, especially for those conditions that would not be expected to cause focal symptoms or signs. This was the case for five of the top seven conditions listed (systemic infection, toxic-metabolic, cardiac, syncope, and vertigo). Daily experience suggests that patients and primary care physicians consider stroke a top diagnostic possibility (even in the presence of nonfocal symptoms) not because it is the most

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