Abstracts

Rationale: Stroke and epilepsy are prevalent neurological conditions. Initial evaluation can be difficult and misdiagnosis is common. The University of Colorado has a stroke alert system and expedites evaluation, workup and the diagnosis for potential acute treatment of ischemic stroke. We evaluated a sample of stroke alert cases to identify predictors for the correct diagnosis of seizure versus stroke. Using this information, our goal is to identify predictors of the correct diagnosis to reduce the numbers of misdiagnosed patient's and reduce the time to treatment. Methods: Stroke alert cases were collected from July 2010 through June 2011. Medical records were reviewed and stroke alert characteristics were analyzed including the following: Presenting signs and symptoms, initial differential diagnosis, final diagnoses, age, sex, ethnicity, atherosclerotic risk factors, (tobacco history, hypertension, diabetes mellitus), previous history of stroke or seizure, alcoholism, history of traumatic brain injury, living situation, history of brain tumor, family history of stroke and/or seizure. Analysis of these items will be analyzed with respect to the final diagnosis. Results: We collected to 725 cases. 30.8% of the stroke alerts had a final diagnosis of TIA or stroke. 7.1% and a final diagnosis of seizure. Other diagnoses included neurologic malignancies, delirium, conversion disorder, metabolic derangement, non-epileptic seizures, and infection. 66% of the patients diagnosed with TIA or stroke were greater than 50 years of age and 72% of patients with the diagnosis of seizure were greater than 50 years of age. 46% of the TIA or stroke patients were women. Data analysis suggests that epidural carotid risk factors were associated strongly with both stroke and seizure. Chronic alcohol use, family history of seizure, previous history of traumatic brain injury, history of brain tumor, and previous history of seizure appear to be associated with a final diagnosis of seizure. Our analysis will continue to focus upon these factors and associations in an attempt to identify predictors for a more accurate initial diagnosis when a stroke or seizures are considered in the diagnosis of an acute event.Conclusions: Age and gender did not seem to be a predictor of the diagnosis of stroke versus seizure. Atherosclerotic risk factors were common to both of those diagnoses. A Significant percent of patients for which a stroke alert is called do not have primary cerebral vascular disease and a common final diagnosis was epileptic seizures.