Younger Stroke Victims Benefit from Earlier MRIs

Performing magnetic resonance imaging (MRI) sooner on younger stroke patients entering emergency rooms (ERs) can lower the rate of misdiagnosis and lead to more timely appropriate treatment.

While the American Stroke Association reports that stroke is the third leading cause of death and one of the top causes of disability in the United States, young adults demonstrating signs of suffering a stroke are sometimes misdiagnosed in hospital ERs, preventing them from receiving early effective treatment that can avoid serious damage. Researchers from Wayne State University (WSU)-Detroit Medical Center Stroke Program (MI, USA) presented their findings during the American Heart Association/American Stroke Association's International Stroke Conference 2011 in Los Angeles (CA, USA), in February 2011. The investigators studied the cases of 77 patients with a mean age of 37.9 years who reported to an emergency room displaying stroke symptoms. Of those cases, 14.5% of the patients were at first misdiagnosed.

The risk of a misdiagnosis decreased if physicians performed an MRI scan of the patient within 48 hours. The probability of a misdiagnosis increased as the age of the patients decreased. The study concluded that early performance of an MRI leads to greater accuracy of a stroke diagnosis in young adults brought to emergency rooms, and patients younger than 35 years of age are at greater risk of being misdiagnosed when exhibiting stroke symptoms. However, if a patient showing stroke symptoms arrived via ambulance, there was a lower rate of misdiagnosis. The researchers theorized that arrival by ambulance might increase an emergency room staff's perception of the gravity of the patient's condition.

"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 Seemant Chaturvedi, MD, professor of neurology and director of the WSU-DMC Stroke Program. "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. Part of the problem is that the emergency room staff may not be thinking ‘stroke' when the patient is younger. Physicians must comprehend that a stroke is the sudden onset of these symptoms.” Patients arriving with "seemingly trivial symptoms like vertigo and nausea” should be carefully evaluated, he reported. Moreover, he noted that delay could be costly. After 48 to 72 hours, there are no major interventions available to improve stroke outcome.

Intravenous delivery of the clot-dissolving agent tissue plasminogen activator is the only US government-approved treatment for acute stroke. The drug must be given within three hours of symptom onset to reduce permanent disability.

The study's findings build on the team's 2009 study in which members reviewed seven years' worth of data covering 57 patients between the ages of 16 and 50. The patients were enrolled in the Young Stroke Registry at the Comprehensive Stroke Center at the WSU School of Medicine. Four males and three females (average age 34) in the study were misdiagnosed with migraine headaches, vertigo, alcohol intoxication, or other conditions. They were discharged from the ER, but later were found to have suffered a stroke.

Related Links:
Wayne State University-Detroit Medical Center Stroke Program