Patients who present emergently with focal neurological deficits concerning for acute ischemic stroke can be extremely challenging to diagnose and treat. Unnecessary administration of thrombolytics to potential stroke patients whose symptoms are not caused by an acute ischemic stroke—stroke mimics—may result in patient harm, although the overall risk of hemorrhagic complications among stroke mimics is low.
We present a case of a stroke mimic patient with underlying psychiatric disease who was treated with intravenous alteplase on four separate occasions in four different emergency departments in the same city. Although he did not suffer hemorrhagic complications, this case highlights the importance of rapid exchange of health information across institutions to improve diagnostic quality and safety.
Why Should an Emergency Physician Be Aware of This?
Increased awareness of stroke mimics by emergency physicians may improve diagnostic safety for a subset of high-risk patients. Establishing rapid cross-institutional communication pathways that are integrated into provider's workflows to convey essential patient health information has potential to improve stroke diagnostic decision-making and thus represents an important topic for health systems research in emergency medicine.
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Published online: December 02, 2019
Accepted: October 13, 2019
Received in revised form: October 7, 2019
Received: June 21, 2019
Dr. Liberman receives research support from National Institutes of Health, United States grant K23NS107643.
© 2019 Elsevier Inc. All rights reserved.