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Título

UNUSUAL PRESENTATIONS OF SUDDEN FOCAL NEUROLOGICAL DEFICIT: “STROKE CHAMELEONS”

Resumo

INTRODUCTION: Stroke is a medical emergency, present with sudden onset focal neurologic disorder and it may lead to severe disability or death in worse case scenarios. There are false-negatives when the clinical sign suggests other disorder conditions. These are known as “stroke chameleons”. OBJECTIVE: Trace the unusual presentations of sudden focal neurological deficit caused by stroke capable of dismissing the diagnostic suspicion and the appropriate treatment. METHOD: This study is a literature review. The chosen database was PUBMED, with keywords “stroke chameleon” and “stroke”. Inclusion criteria were reviews, systematic reviews, clinical trials and meta-analysis with free full text available, published between 2017 and 2022. RESULTS: The common presenting symptoms include dizziness/vertigo without trigger symptoms, nausea/vomiting, confusion, decreased level of consciousness, altered mental status, generalized weakness, and severe hypertension. In addition, it is presented with wrist drop syndrome purely motor or sensorimotor with hypotonia, decreased myotatic reflexes and normal superficial reflexes during the acute phase of stroke in precentral gyrus. Futhermore, transient global amnesia, hyperkinetic movement disorders defined as abnormal, repetitive, involuntary movements rarely occur in acute stroke presentations. Among these, are the Alien limb syndrome, consisting of involuntary movements and foreign-sense of limb, the Anton’s syndrome, the denial of blindness and confabulation of visual sensory information, and the Gerstmann syndrome consists of a tetrad of symptoms: agraphia, acalculia, finger agnosia, and right–left confusion. A few stroke chameleon cases are diagnosed as psychiatric diseases. CONCLUSION: It appears that detailed history taking, comprehensive neurological examination, and appropriate imaging studies are important to identify the clinic mainfestation and, when acute onset symptoms are present, stroke should be considered.

Palavras Chave

Stroke; Stroke Chameleon; Literature review.