| Abstract [eng] |
Stroke mimics is a heterogeneous group of disorders that present with stroke-like symptoms but are not associated with cerebrovascular damage. The prevalence of stroke mimics varies according to different sources: 4.1%-12.3% in stroke treatment centers (1–3), 31% in emergency departments (4), and 27%-32.6% in the prehospital sector (2,5). Functional neurological disorders constitute up to 30.8% of all stroke mimics and pose significant diagnostic challenges (6). Modern medicine recognizes that functional neurological disorders arise from disrupted nervous system functioning, and although these symptoms lack a structural basis, they are not simulated. In clinical practice, functional neurological disorders are still frequently diagnosed by excluding possible structural causes while overlooking specific characteristics typical of functional neurological disorders. Aim of the study. To analyze the diagnostic challenges and differentiation of functional neurological disorders as stroke mimics. Objectives: 1. To review the epidemiology and classification of stroke mimics, and the prevalence of functional neurological disorders among stroke mimics. 2. To determine the frequency of functional neurological disorders among patients treated with intravenous thrombolysis at the Republican Vilnius University Hospital Stroke Center and compare with data from the literature. 3. To analyze the etiology and pathophysiology, clinical manifestations, diagnostics and differential diagnosis, treatment, prognosis, and outcomes of functional neurological disorders. 4. To propose practical recommendations for the diagnosis and differentiation of functional neurological disorders as stroke mimics in clinical practice. Methodology. Literature review, retrospective analysis of patients treated with intravenous thrombolysis at the Republican Vilnius University Hospital Stroke Center during 2022-2023, and discussion of clinical cases. Results. It was determined that 28 cases of stroke mimics were registered at the Republican Vilnius University Hospital in 2022-2023, of which 2 (7.1%) were attributed to functional neurological disorders. This figure is significantly lower than the data reviewed in the literature, which may indicate possible insufficient recognition and underdiagnosis of functional neurological disorders as stroke mimics. Patients experiencing functional neurological disorders face excessive, inappropriate treatment, do not receive necessary care for functional disorders, and the healthcare system is burdened due to stroke hyperdiagnosis and additional diagnostic tests. Conclusions: 1. Among patients receiving intravenous thrombolysis for suspected ischemic stroke, approximately 10% of cases are stroke mimics. This indicates the complex challenge of differential diagnosis of stroke in the emergency department and the need for improvement in this area. 2. According to literature data, functional neurological disorders constitute a significant proportion of stroke mimics (up to 30.8% of all stroke mimics (6)) ; however, based on Republican Vilnius University Hospital data, they accounted for only 7.1% of all stroke mimics. One possible reason for this discrepancy is potentially insufficient recognition and underdiagnosis of such conditions in Lithuania. 3. The diagnosis of functional neurological disorders still relies predominantly on the exclusion of structural pathology; however, there exist positive clinical signs and diagnostic tests that allow for justified diagnosis and confirmation of these disorders. |
