Stroke chameleons: Acute central pain mimicking acute coronary syndrome.

Details

Serval ID
serval:BIB_F5D96B79F14C
Type
Article: article from journal or magazin.
Publication sub-type
Letter (letter): Communication to the publisher.
Collection
Publications
Institution
Title
Stroke chameleons: Acute central pain mimicking acute coronary syndrome.
Journal
European journal of neurology
Author(s)
Rebordão L., Nannoni S., Strambo D., Michel P.
ISSN
1468-1331 (Electronic)
ISSN-L
1351-5101
Publication state
Published
Issued date
30/07/2020
Peer-reviewed
Oui
Language
english
Notes
Publication types: Letter
Publication Status: aheadofprint
Abstract
"Stroke chameleons" refer to a group of syndromes that initially are not diagnosed as cerebrovascular events, but are then found to represent stroke. The objective of this study was to report on acute ischemic stroke (AIS) patients with chest or epigastric pain of central origin, clinically resembling an acute coronary syndrome (ACS).
We kept a prospective list of AIS patients admitted to our institution between 2002 and 2014 with stroke symptoms appearing as an ACS on first clinical evaluation. For each identified patient, we reviewed clinical and radiological features, delay to correct diagnosis, stroke etiology and three-month functional outcome. Data were mainly extracted from the Acute STroke Registry and Analysis of Lausanne (ASTRAL).
We identified five AIS patients presenting mainly with chest or epigastric pain leading to a wrong diagnosis of ACS. Cardiac evaluation showed minor ECG changes in two patients and isolated troponin elevation in one, subsequently shown to be of non-coronary origin. The correct diagnosis of AIS was made only between 1h and 72h after hospital arrival. Four patients presented a vertebrobasilar stroke. None of the patients received acute stroke revascularization therapy despite two of them being in the time window for such treatment.
Acute ischemic stroke presentation can infrequently resemble an ACS. In cases of negative cardiac work-up, a central origin of chest pain should be considered, especially in the presence of subtle other neurological symptoms or signs. Appropriate diagnosis of stroke could avoid treatment delays and improve outcomes.
Keywords
acute central pain, acute ischemic stroke, stroke chameleons
Pubmed
Create date
13/08/2020 9:12
Last modification date
09/12/2020 7:26
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