ED evaluation of stroke-like symptoms may be more traumatic than actual stroke diagnosis
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Key takeaways:
- Hospitalization for stroke-like symptoms was tied to higher odds of PTSD at 1 month than true stroke diagnosis.
- Preexisting PTSD was linked to higher odds of 1-month PTSD, regardless of the final diagnosis.
Patients who are hospitalized with stroke-like symptoms, but do not experience a stroke, may yet develop PTSD at a higher rate than patients who actually had a stroke, a speaker reported.
Stroke-like symptoms — or stroke mimics — included migraine, numbness and dizziness.
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Findings from the ReACH Stroke study were presented at the International Stroke Conference.
“Stroke mimics matter. As clinicians, we may be quick to dismiss a patient’s less life-threatening diagnosis, such as migraine or vertigo. However, these patients may experience significant psychological distress, which can increase their risk for poorer cardiovascular health,” Melinda Chang, MS, ANP-BC, research nurse at the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center, said in a press release. “Knowing that being evaluated for stroke in an emergency department can itself be a traumatic experience for many people may help health care professionals recognize PTSD symptoms and connect patients quickly to the appropriate resources.
“Stroke specialists typically view stroke mimics as less serious than a confirmed stroke, so we did not expect patients with stroke mimics to be at higher risk for having PTSD at 1-month follow-up,” Chang said. “However, the neurologists on our team have noted that patients with stroke mimics can suffer significant distress from their stroke-like conditions, so our findings support these clinical experiences.”
To assess the association between stroke mimic, stroke or transient ischemic attack diagnosis and likelihood of PTSD 1 month after the index event, Chang and colleagues enrolled 1,000 patients with suspected stroke or TIA (mean age, 62 years; 51% women) who presented at the Columbia University Irving Medical Center from June 2016 to March 2022.
PTSD was evaluated using the PTSD Checklist-5 at index hospitalization and at 1 month after discharge.
The patients’ charts were reviewed by a neurologist, who was masked to PTSD status and provided a final diagnosis of stroke, TIA, stroke mimic or equivocal.
Overall, 59.6% of the cohort was diagnosed with stroke, 7.9% with TIA and 27.4% with stroke mimic, whereas 5.1% was equivocal or missing.
The researchers reported that the most common stroke mimics were migraine and other headaches, peripheral or cranial neuropathy and peripheral vertigo.
At 1 month, the prevalence of PTSD was 15.1% for patients with stroke mimic, 6.3% for those with stroke and 5.5% for those with TIA.
After adjusting for age, gender, ethnicity, NIH Stroke Scale, modified Rankin Scale score and prior PTSD, the odds for PTSD at 1 month were higher for patients diagnosed with a stroke mimic compared with those who actually experienced a stroke (OR = 2.99, 95% CI, 1.45-6.18; P < .01) but not TIA (P = .45).
Preexisting PTSD was the only covariate linked to PTSD at 1 month and was associated with a 10-fold increased likelihood across all diagnoses (OR = 10.32; 95% CI, 5.3-20.1; P < .01), according to the study.
“It is important for people who are evaluated for stroke to know they are not alone if they experience flashbacks, disrupted sleep or feel on edge after their medical event. They should feel comfortable and empowered to report any concerning symptoms to their health care team so they can get the help they need,” Chang said in the release.
Reference:
- Experiencing “stroke-like” symptoms may be more traumatic than an actual stroke. https://newsroom.heart.org/news/experiencing-stroke-like-symptoms-may-be-more-traumatic-than-an-actual-stroke. Published Feb. 1, 2024. Accessed Feb. 7, 2024.
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Chang M, et al. Abstract Poster WP35. Presented at: International Stroke Conference; Feb. 7-9, 2024; Phoenix.
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