Early MRI Needed for Young Adults with Stroke Symptoms

Stroke in young adults is one of the leading causes of disability, and the third leading cause of death, according to the American Stroke Association. Yet with an early MRI scan and the right treatment, the effects from strokes can be can be completely reversed.

However, the problem is that 14.5 percent of young adults are misdiagnosed when they present to the emergency department with neurological symptoms, according to a study just presented at the American Heart Association/American Stroke Association’s International Stroke Conference. And that can lead to death or a life-long disability.

For the study, done by the Wayne State University-Detroit Medical Center Stroke Program, physicians evaluated records from the center’s database of 77 young adults, ages 16 to 49, who were ultimately diagnosed with ischemic stroke. They looked at each patient’s race, whether they arrived by ambulance, whether they underwent MRI within 48 hours, and their initial presentation to the stroke center. They tested the variables against emergency department misdiagnoses.

The authors found that patients who got an MRI scan within 48 hours had fewer misdiagnoses, and patients who were younger than 35 got misdiagnosed more than older patients. Those who arrived by ambulance had a greater chance of a correct diagnosis, and they opined that this was because the staff then gave the possible diagnosis and symptoms more weight. In all, 14.5 percent were initially misdiagnosed in the emergency department.

While the findings are more applicable to neurologists and emergency room staff, “radiologists can also educate their ER colleagues about the value of early MRI in suspected strokes,” said Seemant Chaturvedi, MD, professor of neurology and director of the WSU-DMC Stroke Program.

“Part of the problem is that the emergency room staff may not be thinking ‘stroke’ when the patient is younger,” Dr. Chaturvedi said. “Physicians must realize that a stroke is the sudden onset of these symptoms.” Patients arriving with “seemingly trivial symptoms like vertigo and nausea” should be assessed meticulously, he said.

The authors note that while stroke is a leading cause of disability, it’s also one of the few neurological disorders that physicians have the chance to reverse, leaving few or no deficits. They do this by administering thrombolytic therapy for acute ischemic strokes.

In a previous study, the authors found that posterior circulation strokes were most commonly misdiagnosed in young adults, and these may not show up on early CT. They will show up, however, on MRI, which is the only sensitive method of detection.

The American Academy of Neurology recommends MRI rather than non-contrast head CT to diagnose an acute ischemic stroke within 12 hours.