Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 704-709 (doi:10.1542/10.1542/peds.2005-2676)
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ARTICLE

Mimics of Childhood Stroke: Characteristics of a Prospective Cohort

Renée A. Shellhaas, MD, Sabrina E. Smith, MD, PhD, Erin O'Tool, BS, Daniel J. Licht, MD and Rebecca N. Ichord, MD

Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

BACKGROUND. Little is known about the clinical features and spectrum of diagnoses in children with "stroke mimics," those with acute neurologic deficits but without cerebrovascular diseases.

OBJECTIVES. Our goal was to describe patients with stroke mimics and to determine if clinical features predict benign diagnoses.

METHODS. Our stroke consult team registered a prospective consecutive cohort of 143 patients with acute presentations suspicious for cerebrovascular disease from November 2003 to November 2004. Cases in which stroke was ruled out (stroke mimics) were reviewed for clinical features and diagnostic test results and were classified "benign" if there was no structural brain lesion and there was an expectation of complete recovery.

RESULTS. Of the 143 cases evaluated for suspected stroke, 30 (21%) had stroke mimics. Presenting signs included seizure (n = 11), headache (n = 9), mental status change (n = 6), focal weakness (n = 14), and focal sensory change (n = 7). Eleven patients had "benign" diagnoses (3 migraine, 3 psychogenic diagnoses, 3 musculoskeletal abnormalities, 1 delirium, and 1 episodic vital sign changes). Nineteen patients had "not-benign" diagnoses (3 reversible posterior leukoencephalopathy syndrome, 3 neonatal seizures, 2 vascular anomalies, 2 inflammatory disease, 2 intracranial infection, 2 epilepsy, 2 metabolic stroke, 1 tumor, 1 drug toxicity, and 1 idiopathic intracranial hypertension). Except for the presence of seizures, there were no significant differences in presentation or risk factors between benign and not-benign cases.

CONCLUSIONS. Many disorders mimic childhood stroke. History and clinical presentation often do not distinguish the one third of patients with benign disorders from the two thirds with more serious problems, necessitating timely comprehensive investigations, especially brain MRI.

Key Words: stroke • differential diagnosis • neuroimaging • hemiparesis

Abbreviations: AIS—arterial ischemic stroke • SVT—sinovenous thrombosis • ICH—intracranial hemorrhage • TIA—transient ischemic attack • ADEM—acute disseminated encephalomyelitis • CT—computed tomography • RPLS—reversible posterior leukoencephalopathy syndrome • AVM—arteriovenous malformation • t-PA—tissue plasminogen activator

Accepted Feb 21, 2006.


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