#strokemimic - Twitter Hashtag

about 1 year ago

🧵 Not Every Weakness Is a Stroke Case: 85M s/p motor vehicle accident with acute RUE plegia & RLE weakness. ER pushes for TNK. BP is 220/120. But something doesn’t add up… #NeuroTwitter #StrokeMimic #SpineMRI #MedEd 👇 1/ She’s clutching her neck. Writhing in pain. Right arm pain radiates from neck to hand. She can’t urinate. 🛑 This is not your typical stroke. 2/ 🧠 Neuro exam: RUE: 5/5 shoulder ➝ but 1/5 wrist/finger extension RLE: 2/5 Sensory: intact NIHSS: 3 This is myotomal, not cortical. C7 distribution. 3/ 🚨 Stroke mimics matter. The ER pushed to lower BP and give TNK. But in cord compression, that can be devastating. Lowering BP too aggressively can cut off spinal cord perfusion. 4/ 🧠 CT/CTA: unremarkable. So we ordered a stat MRI C-spine. Here’s what we found 👇 🟢 Green arrow = cord pushed left 🩸 T2 bright, T1 dark = hyperacute blood 🧠 Posterior epidural hematoma 5/ 🧾 Diagnosis: Hyperacute spinal epidural hematoma, post-trauma ➝ Cord compression at C6–C7 🧩 Explains: ✔️ Myotomal RUE weakness ✔️ Severe neck pain ✔️ Urinary retention ✔️ No cortical signs 6/ 🧠 Clinical pearl: 📌 Severe, focal pain 📌 Myotomal or radicular pattern 📌 Urinary retention 📌 Weakness without cortical features 🧠 Think spinal cord, not stroke 7/ 🎯 Don’t let protocol override your clinical judgment. TNK isn’t benign — and this case proves it. 🧪 Trust your neuro exam. You were trained to examine, not just follow flowcharts. #NeuroTwitter #StrokeMimic #NeuroRad #ClinicalReasoning #EMConf #MedEd #NeuroBoards 8/

whitfieldlewis6's tweet photo. 🧵 Not Every Weakness Is a Stroke
Case: 85M s/p motor vehicle accident with acute RUE plegia & RLE weakness.
ER pushes for TNK. BP is 220/120. But something doesn’t add up…
#NeuroTwitter #StrokeMimic #SpineMRI #MedEd
👇

1/
She’s clutching her neck.
Writhing in pain.
Right arm pain radiates from neck to hand.
She can’t urinate.
🛑 This is not your typical stroke.

2/
🧠 Neuro exam:

RUE: 5/5 shoulder ➝ but 1/5 wrist/finger extension
RLE: 2/5
Sensory: intact
NIHSS: 3

This is myotomal, not cortical.
C7 distribution.

3/
🚨 Stroke mimics matter.
The ER pushed to lower BP and give TNK.
But in cord compression, that can be devastating.
Lowering BP too aggressively can cut off spinal cord perfusion.

4/

🧠 CT/CTA: unremarkable.
So we ordered a stat MRI C-spine.

Here’s what we found 👇
🟢 Green arrow = cord pushed left
🩸 T2 bright, T1 dark = hyperacute blood
🧠 Posterior epidural hematoma

5/

🧾 Diagnosis:
Hyperacute spinal epidural hematoma, post-trauma
➝ Cord compression at C6–C7

🧩 Explains:
✔️ Myotomal RUE weakness
✔️ Severe neck pain
✔️ Urinary retention
✔️ No cortical signs

6/

🧠 Clinical pearl:

📌 Severe, focal pain
📌 Myotomal or radicular pattern
📌 Urinary retention
📌 Weakness without cortical features
🧠 Think spinal cord, not stroke
7/
🎯 Don’t let protocol override your clinical judgment.
TNK isn’t benign — and this case proves it.
🧪 Trust your neuro exam.
You were trained to examine, not just follow flowcharts.

#NeuroTwitter #StrokeMimic #NeuroRad #ClinicalReasoning #EMConf #MedEd #NeuroBoards
8/

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FNDConnect @ConnectFnd

about 2 years ago

Woman who thought she had pinkeye was actually suffering a 'functional' STROKE - https://t.co/lHnqgkH0ga #FNDaware #functionalneurologicaldisorder #functionalstroke #strokemimic

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Amanda 🏳️‍🌈 @cleggy12

almost 4 years ago

This is how my weeks gone! #stroke #TIA #strokemimic #rehab

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Robert Sarmiento, MD @brainattackmd

almost 4 years ago

Tests for inorganic causes of weakness: 1. Arm-drop test 2. Thigh adduction test 3. Hoover test Thank you, @OGdukeneurosurg for this one! #BrainAttackMD #StrokeMimic #Stroke

Oren Gottfried, MD

@OGdukeneurosurg

almost 4 years ago

#CONVERSION DISORDER: three very important physical exam tests to know how to do.

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Annabella Hampton @annabellaSALT

almost 5 years ago

Really interesting to learn more about approaches to assessment and intervention for FND in a HASU setting. Lots to think about 💭 #FND #stroke #strokemimic #neuro #mySLTday

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Rajiv Advani @rajeroni

over 5 years ago

Strokes should always get a thorough work up. Diagnosing mimics means ruling out strokes! 🧠 #stroke #esoc #savethebrain #strokemimic #wso #asa

Amy Yu, MD @amyyu_md

over 5 years ago

No #sex differences in MRI DWI + in ppl with acute minor neuro sxs presenting to the ED, but more ♀️ than ♂️ are initially diagnosed as mimic. Do you routinely order MRI 🧠to investigate #stroke vs mimic? Read our paper in @GreenJournal https://t.co/WAVFqT2521

amyyu_md's tweet photo. No #sex differences in MRI DWI + in ppl with acute minor neuro sxs presenting to the ED, but more ♀️ than ♂️ are initially diagnosed as mimic. Do you routinely order MRI 🧠to investigate #stroke vs mimic? Read our paper in @GreenJournal https://t.co/WAVFqT2521 https://t.co/QSRDBn4fMq

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Montefiore-Einstein Neurology @NeuroMonteEinst

over 5 years ago

Thanks to the incredible Dr. Ava Liberman for an eye-opening presentation on diagnostic #error at this morning’s #GrandRounds! #meded #strokechameleon #strokemimic @MontefioreNYC

NeuroMonteEinst's tweet photo. Thanks to the incredible Dr. Ava Liberman for an eye-opening presentation on diagnostic #error at this morning’s #GrandRounds! #meded #strokechameleon #strokemimic @MontefioreNYC https://t.co/O49keYvxui

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Limmer Education @LimmerEducation

over 6 years ago

How well do you know stroke? Mimics are common, accounting for 20-25% of suspected presentations. #ems #aemt #paramedic #stroke #strokemimic https://t.co/bJleAkJxgJ

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Susan Palasis @SusanPalasis

almost 7 years ago · Chicago

SWI is great for showing asymmetric hemispheric vessel signal drop out that can clinch this diagnosis. #PediNeuroRad #StrokeMimic

Vicente Martín @vmargar

almost 7 years ago

Acute migraine aura is rare but important in the differential diagnosis among patients with suspected acute cerebral infarction. In these patients abnormalities of atypical stroke perfusion and negative findings of DWI have been observed.

vmargar's tweet photo. Acute migraine aura is rare but important in the differential diagnosis among patients with suspected acute cerebral infarction.
In these patients abnormalities of atypical stroke perfusion and negative findings of DWI have been observed. https://t.co/T5SrpOMo6l

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Megan Rech, PharmD, MS @MeganARech

almost 7 years ago

Is #strokemimic artificially inflating favorable outcomes in stroke patients treated with alteplase? Our new research ⁦@LoyolaHealth⁩ suggests it might https://t.co/DSsp6sUcH1

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Fco Gilo Arrojo @fgiloarrojo

about 7 years ago

70 yo w, acute left hemispheric syndrome, NIH 26. Paradoxically, the blood enters earlier in the symptomatic hemisphere (CT perfusion image acquisition). #strokemimic due to a hypertensive crisis. Normal angio CT and DWI MRI. She wasn't treated with rtPA. 4 days later, NIH 0.

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EMT Review @emtreviewcom

over 7 years ago

Some stroke-like signs and symptoms are not the result of a stroke. How do you spot a stroke mimic? See the case study at https://t.co/U2MWAniKuw #stroke #strokemimic #emergencyresponder

emtreviewcom's tweet photo. Some stroke-like signs and symptoms are not the result of a stroke. How do you spot a stroke mimic? See the case study at https://t.co/U2MWAniKuw #stroke #strokemimic #emergencyresponder https://t.co/FxJvyhkuFL

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Ali S. Raja, MD @AliRaja_MD

over 7 years ago

Frequency, characteristics & aetiology of #StrokeMimic presentations - a narrative review Graham McClelland, MD et al Stroke Research Group, Institute of Neuroscience, UK European Journal of #EmergencyMedicine https://t.co/qhQznkboU7

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Niki Turner @niki_turner

almost 8 years ago

Fantastic talk at #welshstroke2018 by @AlanCarson15 on functional neurological disorders. Perhaps our most common #strokemimic - how safe is #tpa in these cases?

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Montefiore-Einstein Neurology @NeuroMonteEinst

almost 8 years ago

From our Dr. Ava Liberman et al: Inter-rater Agreement for the Diagnosis of #Stroke Versus #StrokeMimic https://t.co/S5IXx9Cw3C

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Joe Acker @AckerJoe

about 8 years ago

@BC_EHS Medical Director @SandraJenneson reminds paramedics of “strike mimics” at Rounds: epidural/subdural bleeds, migraine, Bell’s palsy, carotid/aortic dissection, hypoglycaemia, air embolism, Wernicke’s, brain tumour / abscess, demyelination disease and others. #strokemimic