Distinguishing true strokes from stroke mimics

Summary: This article provides the basis for a quick assessment of the likelihood of a stoke mimic, and therefore infers the likelihood of stroke. The score is not perfect. The presence of isolated sensory deficit at predicting a stroke mimic is interesting. The article does not state whether this finding is due to the presence of Bell’s palsies.

Patients: 784 patients (41% stroke mimics) in the emergency department who received MRI

Examiners: each patient was examined  by both a neurology house staff and a vascular neurologist

Examination method:

FABS (6 variables with 1 point for each variable present):

  1. absence of Facial droop,
  2. negative history of Atrial fibrillation,
  3. Age <50 years, systolic
  4. Blood pressure <150 mm Hg at presentation,
  5. history of Seizures, and
  6. isolated Sensory symptoms without weakness at presentation.

Reference standard: assessment by stroke team after MRI


Accuracy for identifying
stroke mimics

Predictive value for
stroke mimics

(assuming 41% prevalence of stroke mimics)

Finding Sensitivity Specificity Positive predictive value Negative predictive value
Absence of a-fib





Presence of isolated sensory deficit











Goyal N, Tsivgoulis G, Male S, Metter EJ, Iftikhar S, Kerro A, Chang JJ, Frey JL, Triantafyllou S, Papadimitropoulos G, Abedi V, Alexandrov AW, Alexandrov AV, & Zand R (2016). FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department. Stroke; a journal of cerebral circulation, 47 (9), 2216-20 PMID: 27491733

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