Illustrate the epidemiology of functional pseudo-stroke presentations in the emergency department (ED) at a comprehensive stroke center.

There is paucity of literature on patients that are likely to suffer from pseudo-stroke. Few studies noted an incidence rate as high as 15% but include sparse details on demographics and common presentations.

Our ‘stroke-code’ database of ED stroke alerts activated at our comprehensive stroke center between 2016-2022 was reviewed. Patients with documented diagnoses categorized as ‘psychogenic’ (expert evaluation by vascular neurologists, and/or neurology residents closely supervised by attending neurologists) were selected and chart review of presentation, history and hospital course was performed. Data were de-identified and entered in a ‘pseudo-stroke database’ for descriptive analysis.

The mean age of pseudo-stroke patients was 52.3 (range 26-80) and 61.8% (n=21/34) were female. The most prevalent ethnicities were Black/African American (50%) and Caucasian (44.1%). 85.3% smoked tobacco and 94.1% had other medical comorbidities.

Notably, 52.9% of patients had obesity (mean BMI 30.7, SD 8.6). A history of psychiatric illness was noted in 91.2% with the majority (82.4%) diagnosed with depression. 44.1% had anxiety and 38.2% had a history of substance abuse. 26.5% had a previous functional neurological disorder. The prevalent symptoms were numbness (61.8%) and left hemiparesis (58.8%). 88.2% underwent neuroimaging; 73.5% had a CT angiogram and 44.1% had MRI. 17.6% received thrombolytics, with none experiencing hemorrhagic consequences. The majority (35.3%) of patients were admitted to the stroke service, and 23.5% were discharged from the ED.