From the Guidelines
Yes, hospital admission is necessary for suspected conversion disorder versus stroke, as the symptoms of conversion disorder can mimic those of a stroke, and a thorough evaluation is required to determine the underlying cause 1.
Key Considerations
- The American Heart Association emphasizes the importance of prompt recognition and accurate diagnosis of in-hospital stroke, as delayed treatment can result in poor outcomes 1.
- Conversion disorder, also known as functional neurological symptom disorder, can present with symptoms such as weakness, numbness, or difficulty with speech, which can be similar to those of a stroke 1.
- Hospitals should have protocols in place for the evaluation and management of suspected stroke, including the use of stroke alerts and timely activation of thrombolytic or endovascular therapy 1.
- Nurses play a critical role in recognizing symptoms of in-hospital stroke and activating stroke alerts, often doing so earlier than physicians or advanced practice clinicians 1.
- The evaluation of a patient with suspected stroke should include a thorough medical history, physical examination, and diagnostic tests such as imaging studies, to determine the underlying cause of the symptoms and guide treatment 1.
From the Research
Hospital Admission for Suspected Conversion Disorder versus Stroke
- Hospital admission for suspected conversion disorder or stroke is a complex issue, as conversion disorder can mimic stroke symptoms, and vice versa 2, 3.
- Studies have shown that stroke mimics, including conversion disorder, account for almost half of hospital admissions for suspected stroke, highlighting the need for accurate diagnosis to avoid unnecessary treatment and costs 2.
- Conversion disorder can present with dramatic physical symptoms, such as dense hemiparesis, suggestive of severe acute stroke, making it challenging to differentiate from actual stroke 4.
- In some cases, patients with conversion disorder may receive thrombolytic therapy, which can be unnecessary and potentially harmful 5.
- Early psychiatric evaluation and the use of multi-modal CT or magnetic resonance imaging (MRI) can help confirm the diagnosis and differentiate between conversion disorder and stroke 2, 6.
- A non-contrast CT may not be sufficient to make a diagnosis of acute stroke, as the test may be normal very early following an acute stroke 2.
- Comorbidity is common in patients with conversion disorder, and early psychiatric evaluation may assist in the diagnosis and evaluation of patients with suspected conversion disorder 6.