Young adults showing signs of suffering a stroke are being misdiagnosed in hospital emergency rooms, a mistake that prevents them from receiving early treatment that can prevent serious stroke damage, a new study shows.

In a study called "Misdiagnosis of Acute Stroke in the Young During Initial Presentation in the Emergency Room," Wayne State University School of Medicine researchers reviewed data covering 57 patients between the ages of 16 and 50. The patients were enrolled in the Young Stroke Registry at the Comprehensive Stroke Center at the School of Medicine.

Chaturvedi

Four males and three females (average age 34) in the study were misdiagnosed with migraine headaches, vertigo, alcohol intoxication or other conditions. They were discharged and later found to have suffered a stroke. One 48-year-old woman with sudden blurred vision, lack of muscle coordination, difficulty speaking and weakness in her left hand was told an inner-ear disorder caused her symptoms.

"Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems," said Seemant Chaturvedi, M.D., senior author of the study. Chaturvedi is a professor of neurology and director of the WSU/DMC Stroke Program. "We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical."

Chaturvedi is presenting the study's findings Feb. 18 at the American Stroke Association's International Stroke Conference 2009 in San Diego, Calif.

Stroke is the third leading cause of death and one of the top causes of disability in the United States, according to the American Stroke Association.

Chaturvedi said intravenous delivery of the clot-busting drug tissue plasminogen activator (tPA) is the only U.S. government-approved treatment for acute stroke. The drug must be administered within three hours of symptom onset to reduce permanent disability. He noted that some experimental interventional stroke treatment, such as intra-arterial clot busters and mechanical clot retrieval, may be effective for some stroke patients three to eight hours after symptoms develop.

"Part of the problem is that the emergency room staff may not be thinking stroke when the patient is under 45 years old," Chaturvedi said. "Physicians must realize that a stroke is the sudden onset of these symptoms."

Patients arriving with "seemingly trivial symptoms like vertigo and nausea" should be assessed meticulously, he said.
After 48 to 72 hours, there are no major interventions available to improve stroke outcome, Chaturvedi said.

"Early intervention is the most critical component of effective stroke care," said Abraham Kuruvilla, M.D., the study's lead author and a stroke fellow in the School of Medicine's neurology department. "Early intervention will reduce the burden of disability of young patients afflicted with stroke disability and the associated high cost of medical care in this population."

Founded in 1868, the Wayne State University School of Medicine is the largest single-campus medical school in the nation with more than 1,000 medical students. In addition to undergraduate medical education, the school offers master's degree, Ph.D. and M.D.-Ph.D. programs in 14 areas of basic science to about 400 students annually.

Wayne State University is a premier institution of higher education offering more than 350 academic programs through 13 schools and colleges to more than 31,000 students.