Stroke Chameleons and Stroke Mimics in the Emergency Department

Ava L. Liberman, Shyam Prabhakaran

Research output: Contribution to journalReview articlepeer-review

69 Scopus citations


Purpose of Review: We discuss the frequency of stroke misdiagnosis in the emergency department (ED), identify common diagnostic pitfalls, describe strategies to reduce diagnostic error, and detail ongoing research. Recent Findings: The National Academy of Medicine has re-defined and highlighted the importance of diagnostic errors for patient safety. Recent rates of stroke under-diagnosis (false-negative cases, “stroke chameleons”) range from 2–26% and 30–43% for stroke over-diagnosis (false-positive cases, “stroke mimics”). Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. Strategies have been developed to improve detection of posterior circulation stroke syndromes, but ongoing work is needed to reduce under-diagnosis in other atypical stroke presentations. The published rates of harm associated with stroke over-diagnosis, particularly thrombolysis of stroke mimics, remain low. Summary: Additional strategies to improve the accuracy of stroke diagnosis should focus on rapid clinical reasoning in the time-sensitive setting of acute ischemic stroke and identifying imperfections in the healthcare system which may contribute to diagnostic error.

Original languageEnglish (US)
Article number15
JournalCurrent neurology and neuroscience reports
Issue number2
StatePublished - Feb 1 2017


  • Diagnostic error
  • Misdiagnosis
  • Stroke assessment

ASJC Scopus subject areas

  • General Neuroscience
  • Clinical Neurology


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