Background and Purpose: Although we count with effective recanalization therapies for acute stroke treatment, the vast majority of ischemic stroke patients who present within 4.5 hours of symptom onset are still left untreated. We hypothesized that lack of early stroke recognition, mainly due to stroke symptoms disguising as “stroke chameleons”, is a possible explanation.
Methods: Retrospective cross-sectional analysis was performed on 9-year hospital chart records. Patients with discharge diagnoses of ischemic stroke were traced back to their admitting diagnoses. Cases with non-cerebrovascular events admitting diagnoses were identified as possible stroke chameleons and sorted into groups according to the occurrence of presenting neurological or non-neurological manifestations.
Results: Of 1,754 ischemic stroke cases, 678 (38.7%) were found to be possible stroke chameleons. More than half of the chameleons (58.6%) presented with neurological manifestations. The four most common ones were disorders of somatic sensation (31.7%), alteration of consciousness (31.5%), disorders of speech/language (10.8%), and disorder of motility (10.1%). The rest of possible stroke chameleons camouflaged themselves with presenting manifestations pertaining to conditions of other organ systems such as cardiopulmonary, gastrointestinal, systemic infection, trauma, and vascular events elsewhere.
Conclusions: We found a large percentage of possible stroke chameleons. In this new era of effective recanalization therapies for ischemic stroke, more attention should be placed on stroke chameleons. More studies should confirm our results and the proper efforts should be taken to increase the number of patients treated for acute ischemic stroke that arrive within the therapeutic window.