Walsh & Hoyt: Diagnosis

The diagnosis of ""stroke"" is based on clinical definitions and can be difficult, especially in the setting of TIA. There are few data about in-hospital diagnostic accuracy of stroke. In 1999, Allder et alreported an 8.6% rate of clinical misdiagnosis in a study of 70 patients who were thought to have carotid distribution ischemia and were imaged at a mean of 11.4 hours post-onset. Of some interest to those involved in triaging patients for acute treatments, data have been reported for the pre-hospital diagnosis of hyperacute cerebrovascular disease by paramedical personnel using a variety of protocols with positive predictive values of about 70%80%. With the development of new drugs used within the first few hours after a stroke, accurate diagnosis by paramedical personal and non-neurologists such as emergency room physicians has become essential.