Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Stroke mimic diagnoses presenting to a hyperacute stroke unit

Oscar MP Jolobe
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.17-1-95a
Clin Med February 2017
Oscar MP Jolobe
Manchester Medical Society, Manchester, UK
Roles: retired geriatrician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Editor – The study that showed that access to magnetic resonance imaging (MRI) facilitated the diagnosis and management of stroke mimics1 strikes a parallel with another study evaluating MRI after a negative computerised tomography (CT) scan.2 In that study, as many as 11.5% of patients who had a non-diagnostic CT scan after presenting with atypical stroke symptoms were subsequently shown to have subacute infarcts when MRI was performed within 24 hours of the negative CT scan.2 These observations are strong arguments for an MRI-first policy along the lines demonstrated in a recently reported ‘real world’ study.3 In that study, among 314 patients with suspected stroke who were screened solely by MRI, 73 proceeded to intravenous thrombolysis. Thanks to a concurrent quality improvement (QI) strategy, door-to-needle time (DNT) significantly improved during the three phases of implementation of the MRI-first policy such that median DNT amounted to 83 minutes, 68 minutes and 54 minutes in phases I, II and III, respectively (p<0.001). Exceptions to MRI-first included contraindications to MRI (one patient) and poor general condition (two patients).

The QI process included pre-notification by the emergency medical service, limiting the MRI sequence and introduction of a rapid examination tool.3 The disadvantage of MRI being more time consuming than CT scanning can be mitigated by applying novel strategies to reduce the time taken by high computation processes, such as diffusion-weighted imaging. High angular resolution diffusion imaging is one such strategy. In theory, this strategy is capable of reducing computation time by about 50% without any reduction in result quality.4

Conflicts of interest

The author has no conflicts of interest to declare.

  • © Royal College of Physicians 2017. All rights reserved.

References

  1. ↵
    1. Dawson A
    , Cloud GC, Pereira AC, Moynihan BJ. Stroke mimic diagnoses presenting to a hyperacute stroke unit. Clin Med 2016;16:423–6.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Hammoud K
    , Lafranchi M, Li SX, Mehan WA. What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke? Emerg Radiol 2016;23:339–44.
    OpenUrl
  3. ↵
    1. Sakamoto Y
    , Tanabe M, Masuda K, et al. Feasibility of using magnetic resonance imaging as a screening tool for acute stroke thrombolysis. J Neurol Sci 2016:368;168–72.
    OpenUrl
  4. ↵
    1. Loro NF
    , Ibanez A, Lavrador R, et al. Processing time reduction: an application in living human high-resolution diffusion magnetic resonance imaging data. J Med Syst 2016:40:243.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Stroke mimic diagnoses presenting to a hyperacute stroke unit
Oscar MP Jolobe
Clinical Medicine Feb 2017, 17 (1) 95-96; DOI: 10.7861/clinmedicine.17-1-95a

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Stroke mimic diagnoses presenting to a hyperacute stroke unit
Oscar MP Jolobe
Clinical Medicine Feb 2017, 17 (1) 95-96; DOI: 10.7861/clinmedicine.17-1-95a
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Conflicts of interest
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
  • Response
  • Functional disorders and chronic pain
Show more Letters to the editor

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians