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Research paper
Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit
  1. Sergios Gargalas1,
  2. Robert Weeks1,
  3. Najma Khan-Bourne1,
  4. Paul Shotbolt2,
  5. Sara Simblett2,
  6. Leah Ashraf3,
  7. Claire Doyle1,
  8. Victoria Bancroft1,
  9. Anthony S David4
  1. 1Department of Stroke Medicine, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Department of Neuropsychiatry, South London & Maudsley NHS Foundation Trust, London, UK
  3. 3Department of Medicine, King's College London, London, UK
  4. 4King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
  1. Correspondence to Professor Anthony S David, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, P.O. Box 68, London SE5 8AF, UK; anthony.david{at}


Background Some patients admitted to acute stroke units are diagnosed as stroke mimics. A minority have a functional neurological disorder (‘functional mimics’).

Aims To determine the incidence of functional stroke mimics admitted to a hyperacute stroke unit (HASU); to compare their clinical characteristics with medical mimics and stroke cases and obtain information about outcomes.

Methods Patients admitted to the King's College Hospital HASU between 2011 and 2012 were analysed. Data were obtained from the Stroke Improvement National Audit Programme (SINAP) database. Expert consensus diagnosis was used to classify functional mimics. Follow-up information was obtained from a retrospective case series in primary care over the year following discharge.

Results 1165 patients were admitted to the HASU; 904 patients with stroke (77.6%), 163 medical mimics (14%) and 98 functional mimics (8.4%). Functional mimics were significantly more likely to be female (63.3%) versus 49.7% medical mimics and 45.5% stroke, and younger (mean age (SD)) 49.1 (18.8) than medical mimic (63.5 years (16.7)) and stroke cases (71 years (15.5)). Weakness and slurred speech were the commonest presentations of functional mimics and diagnostic MRI was used more often. Clinician recorded visual and speech symptoms and neglect were significantly more frequent in patients with stroke than either mimic group. Of the 68 functional mimics on whom follow-up information was obtained, 40 (59%) were referred to another service most often for a psychologically-based intervention.

Conclusions Functional stroke mimics are an important subgroup admitted to acute stroke services and have a distinct demographic and clinical profile. Their outcomes are poorly monitored. Services should be developed to better diagnose and manage these patients.

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  • SG and RW are joint first authors.

  • Contributors ASD, RW, NK-B and PS conceived and designed the study and with SG, carried out the consensus diagnoses. SG conducted data extraction and data analysis supervised by ASD. SS, CB, VD collected follow-up data. LA extracted information on medical mimics. ASD drafted the paper. All authors contributed to editing the paper and all authors approved the final manuscript. ASD is guarantor. ASD was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London & Maudsley NHS Trust and Institute of Psychiatry, King's College London.

  • Competing interests None declared.

  • Ethics approval This study conformed to local approval standards for audit.

  • Provenance and peer review Not commissioned; externally peer reviewed.