Young Adult Stroke Patients May Be Misdiagnosed in the Emergency Room

Young adults with stroke symptoms are sometimes misdiagnosed in the emergency room (ER), making them miss effective early treatment, according to a new study.

Researchers from Wayne State University (Wayne; Detroit, MI, USA) reviewed data on 57 patients (ages 16 to 50), who were enrolled in the young stroke registry at Wayne since 2001. Four males and four females (14% of the patients), with an average age of 34, were misdiagnosed as having vertigo, migraine, alcohol intoxication, or other conditions. They were discharged from the hospital and later discovered to have suffered a stroke. Those misdiagnosed included an 18-year-old man who reported numbness on his left side but was diagnosed with alcohol intoxication; a 37-year-old woman who arrived with difficulty speaking and was diagnosed with a seizure; and a 48-year-old woman with sudden blurred vision, an off-balance walk, difficulty of speaking, lack of muscle coordination, and weakness in her left hand, who was told she had an inner ear disorder. The study was presented at the American Stroke Association's International Stroke Conference, held during February 2009 in San Diego (CA, USA).

"Early intervention is the most critical component of effective stroke care,” said lead author Abraham Kuruvilla, M.D., of the department of neurology. "Early intervention will reduce the burden of disability of the young patients afflicted with stroke disability and the associated high cost of medical care in this population.”

"Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems,” said senior author Seemant Chaturvedi, M.D., a professor of neurology and director of the stroke program at Wayne. "We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical.”

Stroke symptoms that require further investigation include sudden numbness or weakness of the face, arm or leg (especially on one side of the body); sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and severe headache with no known cause. Intravenous delivery of the clot-busting drug tissue plasminogen activator (tPA) must be delivered within three hours of symptom onset to reduce permanent disability caused by stroke. After 48-72 hours, there are no major interventions available to improve stroke outcome.

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