Abstract

VIRUEZ SOTO, José Luis; VERA CARRASCO, Oscar; TORREZ CRUZ, Karen Mabel  and  BAILEY ROJAS, Franz Bruno. DIAGNOSTIC ERRORS IN STROKE. Rev. Méd. La Paz [online]. 2011, vol.17, n.1, pp.16-21. ISSN 1726-8958.

Cerebral Vascular Accident (CVA) is the third leading cause of death and disability in the first of many developed countries, affecting mostly middle-aged adults and the elderly. However, in our environment do not exist publications that show the prevalence of this disease. Study Objective: This study aims to establish the prevalence of false AVC (FAVC) in patients treated at emergency services (SE), neurology and intensive care clinics Hospital and National Institute of Chest Diseases (INT). Material and methods: Cross-sectional descriptive of all diagnosed cases of AVC for twelve consecutive months (January to December 2009), emergency services, neurology clinics and Hospital Intensive Care Unit of the INT, La Paz, Bolivia. The information was obtained by reviewing medical records. Inclusion criteria: patients with ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA) evaluated by neurology/neurosurgery and uncertain diagnosis of stroke. We excluded patients with subarachnoid hemorrhage (SAH), subdural and epidural hematomas. A diagnosis ofFAVC according to the criteria ofthe guidelines of the World Health Organization (WHO) published in 2005, "WHO STEPS Stroke Manual". Results: From January to December 2009, attended a total of 385 stroke patients, of whom 110 were classified as TIA (31%), 191 ischemic stroke (53%) and 57 hemorrhagic stroke (16%). Were found in 65 FACV records, corresponding to 18.2% of all patients included in the study, average age 79 years, with higher prevalence in women 64.6%. Most common alternative diagnoses: syncope/presyncope (10.8%), delirium (21.5%), decreased level of consciousness (27.7%), generalized weakness (6.2%), seizures 6.2%. 71.7% ofthe FAVC were attributed to systemic causes. CT brain was performed in 70.8% of cases of FAVC. Were discharged 27% of all AIT, 27% of ischemic stroke and 1.7% of hemorrhagic stroke. Conclusion We can say that in patients with acute cerebrovascular disease, diagnostic errors in a considerable percentage. This is evidenced primarily in the emergency services, where nearly a third of all diagnosed cases of stroke and nearly half of the diagnoses of TIA are discharged can be misleading. Most of the false diagnoses occur in elderly patients with systemic disease and are not valued by neurology and/or neurosurgery.

Keywords : FAVC; diagnosis; prevalence.

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