missed stroke

The diagnosis of stroke remains a challenge, due to overlapping symptoms with other conditions, limitations in diagnostic tests, and lack of awareness of posterior circulation presentation and workup. Below is a brief overview of the rate and risk factors for missed stroke, common stroke mimics and chamelons, and the challenge of diagnosing stroke in patients…

bouncebacks: posterior circulation stroke

Posterior circulation strokes are less common and have a wide spectrum of symptoms and signs, so it’s not surprising they are easily missed. Here are a few misses/near misses, and their associated misdiaganoses   ‘GASTRO’ 60yoM with a history of DM/HTN presents with dizzy/vomiting all day, one diarrhea. No documented neuro exam, given fluids and…

bounceback: vision loss

Two bounceback cases highlighted the importance of considering occipital stroke and examining for visual field defects CASE 1 47F HTN/lipid c/o decreased vision left eye O/E decreased visual field left eye, sent to ophtho Ophtho found homonymous hemianopsia, send back for CT: occipital infarct   CASE 2 61M HTN/smoke c/o decreased peripheral vision right eye…

missed cerebellar infarction

Pitfalls in the Diagnosis of Cerebellar Infarction. Acad Emerg Med 2007;14:63-68. This retrospective review of 15 cases of misdiagnosed cerebellar infarction sheds light on a number of preventable errors. 28yo with headache, vertigo, nausea, fall to left, vision loss. Left sided weakness on exam but no documented gait. Normal CT/MRI. Diagnosed as migraine 38yo with…