Stroke Mimics or Are They?

Sue Newsome shares her experience of her father being mis-diagnosed with a Stroke Mimic


My Dad had a Stoke on the 15th of June 2015, a date that will be forever etched in my memory. Dad phoned me and said ‘Sue I’m scared I’m having a Stroke, I know because I have watched the adverts on TV’. ‘My vision and my balance have gone’. Dad sounded petrified and his speech was slurred. I told him I would phone his neighbour to sit with him and I would call an ambulance and then head over. I live in Stockport, Dad lived in Huddersfield. I explained all of Dad’s symptoms to the call handler and then set off to Dad’s. I arrived at Huddersfield A&E about an hour and a half after Dad’s call. I had several missed calls from my partner so I phoned him. Paramedics had contacted him to say that they didn’t feel there was any reason to take Dad to hospital as he wasn’t having a Stroke. I was shocked and phoned them as requested at Dad’s. They informed me that he wasn’t having a Stroke, I explained that I thought that he was from his description of events, but I would leave the hospital and meet them at Dad’s. This was to be my first mistake. When I arrived at Dad’s he was confused and disoriented and his speech was slurred. They asked if he always spoke like that and I explained he didn’t. They told me that Dad was FAST (Face, Arm, Speech, Time) negative despite me reiterating Dad’s earlier description of his symptoms. I explained Dad was Diabetic and they told me he had AF as they had carried out an ECG. I would subsequently find out that these were both ‘Red Flag’ indicators to consider a Stroke. I was told Dad didn’t want to go to hospital, Dad never said this to me. Can someone who is confused and experiencing a Stroke be considered to have capacity? I reiterated I thought Dad was having a Stroke several times. I was asked to stay with Dad overnight and call his GP out the next day. This was to be my second and fatal mistake. I agreed to this reluctantly. Dad’s confusion worsened, I called his GP the following morning. He came out took one look at Dad and said he wasn’t right and he would arrange for Dad to go to the Stroke Unit immediately. I drove Dad to Halifax where his scan revealed he had experienced a Stroke. This led to Dad developing Vascular Dementia and dying after 15 months of devastating declining health. 

I am aware that there is some recent research into adding Visual and Balance disturbances into the FAST diagnostic assessment and I am keen for this to be developed. Had this been part of FAST when Dad experienced his Stroke the outcome for him could have been very different.

I would also like to discuss the current trend in Stroke research. I am aware that current research patterns to identify effective Stroke Pathways are focusing on ‘Stroke Mimics’. For the majority of people and HCP’s this is a positive step facilitating effective identification and ensuring the most appropriate care pathway using accurate clinical diagnostic tools. This therefore enables the person to be conveyed to the correct hospital or Regional Stroke Unit. It ensures the most effective use of limited specialist Stroke resources. 

Conversely to balance out the effectiveness of identifying Strokes and teasing out the Stroke Mimics there needs to be research conducted into the percentage of people who are identified as Stroke Mimics but are in fact having a Stroke. What is the cost financially both to them and to the NHS for their post Stroke care.  Also, the impact on personal lives and on families from a misdiagnosis. Effective diagnostic tools are essential if these Strokes incorrectly diagnosed as Mimics are to be minimised. The FAST test is not a fool proof clinical diagnostic tool and some Strokes aren’t identified using this diagnostic criteria. 

My concern is whilst the emphasis is on identifying Stroke Mimics is there going to be an increase in missed Strokes because they aren’t identified using FAST and are deemed FAST negative and consequently don’t receive treatment at a Regional Stroke Unit. As Stroke treatment is time critical there is very little time to waste. From personal experience misdiagnosing a Stroke as a Stroke Mimic has devastating life changing consequences. I would respectfully ask all paramedics to listen to their patients experiences carefully and their families accounts. I didn’t feel that Dad or I was listened to. It was ultimately my decision to agree for Dad to stay at home on the paramedics advice. This is a decision I will bitterly regret for the rest of my life. Had Dad been taken to hospital he may have been suitable for a Thrombolysis and his last 15 months of life would not have been experienced the trauma of Vascular Dementia.
University of Kentucky. "Study supports change to FAST mnemonic for stroke." ScienceDaily. ScienceDaily, 23 February 2017.

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Aroor S, et al. Stroke. 2017. 

Sue Newsome