Diagnostic challenges in emergency stroke: a case series.

Background: Acute ischemic stroke (AIS) is a disease associated with high rates of death and disability. The most effective treatment for AIS is intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). In the acute phase of AIS, the accuracy of diagnosis is crucial for deciding on IVT and MT, but can be complicated by the presence of a large number of stroke mimics (SMs) and stroke chameleons (SCs). In this paper, to improve the identification of true stroke from false stroke at the early stage, we innovatively present a rare case series of SMs and SCs categorized by subject modes.

Case description: We present a series of retrospective cases in the Affiliated Hospital of Guangdong Medical University. All cases presented with acute onset. These nine rare cases highlight SMs and SCs that were classified into three categories: epilepsy, metabolic disorders, and myelopathy. The main diagnoses of these cases included AIS, epilepsy, metabolic disorder, and myelopathy. Due to our timely diagnosis and correct treatment, most patients showed improvement in symptoms during follow-up.

Conclusions: These cases can aid in distinguishing AIS from other diseases in the early stages, thereby reducing the rates of misdiagnosis and missed diagnosis, especially in the emergency department. Ultimately, this can prevent patients from undergoing unnecessary examinations and treatments while ensuring they receive timely and proper treatments. However, it is important to note that excessive pursuit of diagnostic accuracy may delay the timely application of IVT and MT for patients.