Interdisciplinary Neurosurgery (Dec 2023)
Misdiagnosis of acute basilar artery occlusion (BAOs) in the emergency department in vietnam: A single-center, retrospective, cross-sectional study
Abstract
Background: Ischemic stroke caused by basilar artery occlusions (BAOs) poses a risk for misdiagnosis, leading to an increase the rates of mortality and disability, particularly in low-, and middle-income countries. Methods: A retrospective and cross-sectional study evaluated 21 patients with an initial misdiagnosis of BAO among 110 BAO patients from 7 district hospitals who were subsequently admitted to the stroke center at the 103 Military Hospital from June 2021 to September 2022 in Ha Noi city, Vietnam. Patient data collected were age, sex, medical history, initial diagnosis, neuroradiologic findings, and treatment outcome at 1 month after hospital discharge. Results: The rate for misdiagnosis for BAOs in the initial emergency department (ED) was 19.1%. The average patient age was 68.9 (63–81) years. The most common symptom at the disease onset was dizziness, followed by altered consciousness, seizures, quadriplegia, hemiplegia, functional swallowing disorder, and breathing disorders. Vestibular disorder was the most common misdiagnosis of BAOs, followed by epilepsy, hypoglycemia, and delirium tremens, impaired consciousness with unknown cause, polyneuritis, and aspiration pneumonia. Cerebral infarction was not detected in all brain computed tomography images, but was detected in brain magnetic resonance images. The average score of the Modified Rankin Scale was 5.4 ± 0.5, and 47.6% of the patients who died after 1 month from the hospital discharge. Conclusion: Misdiagnosis of BAOs at the initial ED visit resulted in serious consequences. We highly recommend the use of brain magnetic resonance imaging as the preferred imaging method for patients with suspected BAOs who present to the ED.All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. All authors have read and approved the final submitted revised manuscript.
