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

Findings:

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

96

17

45

86

Presence of isolated sensory deficit

15

97

77

62

FABS≥3

90

91

87

93

Citation

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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