Wallace Emma J C, Liberman Ava L
Montefiore Medical Center, Albert Einstein College of Medicine, Department of Neurology, Bronx, NY, USA.
Neuropsychiatr Dis Treat. 2021 May 13;17:1469-1480. doi: 10.2147/NDT.S275750. eCollection 2021.
Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone to missed or delayed diagnosis. We therefore detail common stroke chameleon symptoms as well as atypical stroke presentations, broadly review new developments in the study of diagnostic error in the outpatient setting, suggest practical clinical strategies for diagnostic error reduction, and emphasize the need for rapid consultation of stroke specialists when appropriate. We also address the role of psychiatric disease and vascular risk factors in the diagnostic evaluation and treatment of suspected stroke/TIA patients. We advocate incorporating diagnostic time-outs into clinical practice to assure that the diagnosis of TIA or stroke is considered in all relevant patient encounters after a detailed history and examination are conducted in the outpatient setting.
未能及时诊断短暂性脑缺血发作（TIA）或中风与患者的高发病率和死亡率相关。在门诊或诊所环境中，我们怀疑脑血管疾病表现轻微、短暂且不典型的患者最容易漏诊或延误诊断。因此，我们详细介绍常见的中风伪装症状以及不典型的中风表现，广泛回顾门诊环境中诊断错误研究的新进展，提出减少诊断错误的实用临床策略，并强调在适当情况下迅速咨询中风专家的必要性。我们还讨论了精神疾病和血管危险因素在疑似中风/TIA患者诊断评估和治疗中的作用。我们主张将诊断暂停纳入临床实践，以确保在门诊进行详细病史询问和检查后，在所有相关患者就诊时都考虑到TIA或中风的诊断。
