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Chameleons, confusion, and the Clinical Historian
  1. Tom Hughes
  1. Correspondence to Dr Tom Hughes, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; Tom.Hughes2{at}wales.nhs.uk

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The negative symptoms, absence of pain, immature signs and evolving story coupled often with communication problems from the outset militate against quick and easy diagnosis in acute stroke; add in the inherent risks of thrombolysis and the still prevalent culture of stroke not being an emergency, and we have the makings of a perfect clinical storm.

These case reports reflect some of these difficulties using the idea of mimics (looks like one, but isn't) and chameleons (doesn't, but is). But like any diagnosis, mimics and chameleons are in the eye of the beholder and arguably their existence is as much a product of the perceptions and working practice of healthcare professionals in the acute stroke environment as they are a consequence of anything biologically unusual about the cases in question. So, is there something different about acute stroke that makes diagnoses more difficult to clinch? Urgency is the most obvious factor. The time window for symptom to syringe must be as short as you can make and we just have to get better at thinking very much more quickly, usually while standing beside a trolley.

However, there are other diagnostic pitfalls that may not be apparent to those unencumbered with responsibility for final diagnosis and some are unforeseen consequences of the early use of labels, ‘tools’ and codes which have installed themselves as substitutes for diagnostic thinking.

The labels, Stroke and transient ischaemic attack …

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