Top Tweets for #strokemimic
🧵 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/

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

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

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

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

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

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

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
Fantastic talk at #welshstroke2018 by @AlanCarson15 on functional neurological disorders. Perhaps our most common #strokemimic - how safe is #tpa in these cases?
From our Dr. Ava Liberman et al: Inter-rater Agreement for the Diagnosis of #Stroke Versus #StrokeMimic
https://t.co/S5IXx9Cw3C
@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


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