Search

Several diseases produce symptoms similar to those of a cerebral stroke, resulting in their misdiagnosis as stroke. Cerebral stroke mimics are common in emergency rooms. We report two cases of cerebral stroke mimics to attract the attention of clinicians, especially emergency room doctors. In one case, a patient with spontaneous spinal epidural hematoma (SSEH) exhibited lower-right limb numbness and weakness. In the other, a patient with spinal cord infarction (SCI) had numbness and weakness of the lower-left limb. Both cases were misdiagnosed as cerebral strokes in the emergency room. One of the patients underwent hematoma removal surgery, and the other received medical treatment for spinal cord infarction. Patients’ symptoms improved, but the sequelae remained. Single-limb numbness and weakness are an uncommon initial presentation of spinal vascular disease that can lead to its misdiagnosis. When encountering single-limb numbness and weakness, it is necessary to consider the differential diagnosis of spinal vascular disease, thereby reducing misdiagnosis.

Rationale: Intracranial vascular atherosclerotic occlusion is one of the most common causes of ischemic stroke world wide. The involvement of large intracranial vessels, in particular, the middle cerebral artery, is usually associated with unfavorable outcomes in patients. Spontaneous recanalization of atherosclerotic occlusion is relatively rare. Patient concerns: The first patient was a 43-year-old male with slurred speech and left-sided weakness for a duration of 24 hours. The second was a 59-year-old male with left-sided weakness over a period of 13 hours. The last was a 49-year-old female patient presented with a 1-month history of right-sided headache. Diagnoses: Atherosclerotic middle cerebral artery occlusion. Interventions: In all cases, oral aspirin (100 mg; once daily), Plavix (75 mg; once daily), and Lipitor (40 mg; once daily) were used . Oral Plavix was stopped 3 months. Outcomes: Spontaneous recanalization occured in the three cases of atherosclerotic middle cerebral artery occlusion. Lessons: Spontaneous recanalization may occur in both early and late stages of atherosclerotic middle cerebral artery occlusion. Clinicians should be aware of this particular condition, as it may represent a relatively favorable prognosis.