Abstract Number: Esoc2026a789 Prevalence and Clinical Characteristics of Stroke Mimics Among Patients With Suspected Acute Stroke in the Emergency

Abstract Background and aims Objective: Stroke mimics present a diagnostic challenge in the emergency department (ED). We aimed to determine the prevalence, aetiologies, and clinical predictors of stroke mimics in patients presenting with suspected acute stroke within 9 hours of symptom onset. Methods This retrospective cohort study analysed 3,170 adult patients triaged via the Stroke Fast-Track protocol at Srinagarind Hospital between January 2020 and December 2024. Final diagnoses were confirmed by neurologists. Statistical analyses were performed using R software, including descriptive statistics and univariate logistic regression to identify symptom predictors of stroke mimics. Results Of 3,170 patients, 564 (17.8%) were diagnosed with stroke mimics. The most common aetiologies were seizure-related (16.3%), cardiovascular (11.7%), and infectious disorders (11.2%). Symptoms significantly associated with mimics included seizure (OR 4.95), memory disturbance (OR 3.59), fever (OR 3.43), dizziness, headache, and blurred vision. Conversely, classic focal deficits including motor weakness (OR 0.45), dysarthria (OR 0.59), and facial palsy (OR 0.79) were negatively associated with mimics, indicating a higher likelihood of true stroke. Conclusions Stroke mimics accounted for 17.8% of Fast-Track activations, with seizures and infections being common causes. Clinicians should remain vigilant for atypical features such as fever and memory disturbance to distinguish mimics from true strokes, whilst recognising that classic focal deficits strongly favour a stroke diagnosis. Conflict of interest Dr.Supachai nothing to disclose