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