• Narushi Sugii, Alexander Zaboronok, Hiroyuki Fujimori, Naoaki Sato, Keishi Fujita, Eiichi Ishikawa, and Akira Matsumura.
• Department of Neurosurgery, Kobari General Hospital, Chiba, Japan; Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan.
• J Stroke Cerebrovasc Dis. 2019 Apr 1; 28 (4): 1078-1084.

BackgroundStroke mimics (SMs)are medical conditions that are at first considered to be of cerebrovascular etiology but turn out to be a condition other than stroke. While many reports on SMs have been published, there have been none from Japan. Thus, we sought to assess the current state of SMs in a Japanese population.MethodsWe collected data of patients referred with suspicion of stroke to neurosurgeons by emergency department (ED) doctors, and we retrospectively evaluated the diagnosis concordance rate between the ED doctors and the neurosurgeons. We also assessed the plausible causes leading to misdiagnosis of stroke.ResultsOf the 226 consecutive referrals with suspicion of stroke, only 71.7% were accurate. Furthermore, 75% of the SMs were disorders unrelated to neurosurgery, such as psychiatric disorders, peripheral dizziness/vertigo, and cardiovascular events. In other words, referring those patients to neurosurgeons was inappropriate. We found that perceived notion or premature assumption of stroke accounted for 43.8% of the stroke mimic patients and was the most important reason for the misdiagnosis.ConclusionsThis is the first report on SMs in a Japanese population. About one-third of all referrals with suspicion of stroke made by ED doctors were inappropriate. Including more information on stroke diagnosis in the educational program for young doctors in Japan would be beneficial for improving the quality of the initial medical examination of patients with suspected stroke.Copyright © 2019 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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