Department of Stroke Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Department of Neuropsychiatry, South London & Maudsley NHS Foundation Trust, London, UK.
J Neurol Neurosurg Psychiatry. 2017 Jan;88(1):2-6. doi: 10.1136/jnnp-2015-311114. Epub 2015 Aug 28.
Some patients admitted to acute stroke units are diagnosed as stroke mimics. A minority have a functional neurological disorder ('functional mimics').
To determine the incidence of functional stroke mimics admitted to a hyperacute stroke unit (HASU); to compare their clinical characteristics with medical mimics and stroke cases and obtain information about outcomes.
Patients admitted to the King's College Hospital HASU between 2011 and 2012 were analysed. Data were obtained from the Stroke Improvement National Audit Programme (SINAP) database. Expert consensus diagnosis was used to classify functional mimics. Follow-up information was obtained from a retrospective case series in primary care over the year following discharge.
1165 patients were admitted to the HASU; 904 patients with stroke (77.6%), 163 medical mimics (14%) and 98 functional mimics (8.4%). Functional mimics were significantly more likely to be female (63.3%) versus 49.7% medical mimics and 45.5% stroke, and younger (mean age (SD)) 49.1 (18.8) than medical mimic (63.5 years (16.7)) and stroke cases (71 years (15.5)). Weakness and slurred speech were the commonest presentations of functional mimics and diagnostic MRI was used more often. Clinician recorded visual and speech symptoms and neglect were significantly more frequent in patients with stroke than either mimic group. Of the 68 functional mimics on whom follow-up information was obtained, 40 (59%) were referred to another service most often for a psychologically-based intervention.
Functional stroke mimics are an important subgroup admitted to acute stroke services and have a distinct demographic and clinical profile. Their outcomes are poorly monitored. Services should be developed to better diagnose and manage these patients.
一些入住急性卒中单元的患者被诊断为卒中样发作。少数患者患有功能性神经障碍（“功能性样发作”）。
确定入住超急性卒中单元（HASU）的功能性卒中样发作患者的发病率；比较其与医学样发作和卒中病例的临床特征，并获得有关结局的信息。
分析 2011 年至 2012 年期间入住英国国王学院医院 HASU 的患者。数据来自国家卒中改善审计计划（SINAP）数据库。采用专家共识诊断对功能性样发作进行分类。通过回顾性初级保健病例系列，在出院后一年获得随访信息。
HASU 共收治 1165 例患者；904 例为卒中（77.6%），163 例为医学样发作（14%），98 例为功能性样发作（8.4%）。功能性样发作患者女性（63.3%）明显多于医学样发作（49.7%）和卒中（45.5%），且更年轻（平均年龄（标准差））49.1（18.8）岁，明显低于医学样发作（63.5 岁（16.7））和卒中患者（71 岁（15.5））。虚弱和言语不清是功能性样发作的最常见表现，且更常使用诊断性 MRI。与任何一种样发作患者相比，临床医生记录的视觉和言语症状以及忽视在卒中患者中更为常见。在获得随访信息的 68 例功能性样发作患者中，40 例（59%）因心理干预而转至其他服务机构。
功能性卒中样发作是急性卒中服务中一个重要的亚组，具有独特的人口统计学和临床特征。其结局未得到充分监测。应开发服务以更好地诊断和管理这些患者。
