title: The differential diagnosis of suspected stroke: a systematic review.
abstract: BACKGROUND
  We aimed to determine the proportion of patients who had suffered a stroke and compare this to those patients with suspected stroke, and the range of differential diagnosis for suspected stroke.
  
  
  METHODS
  We searched for prospective studies of suspected stroke in electronic databases and our personal files. We undertook a meta-analysis of these studies, aimed at determining the proportions of patients with confirmed stroke in different settings.
  
  
  RESULTS
  We identified 29 studies involving 8,839 patients: 13 studies were from emergency departments, five from stroke units or transient ischaemic attack (TIA) clinics, three from primary care, three from ambulance services and five were unspecified. About three-quarters (74% [95% confidence interval (CI): 66 to 83%]) of patients had a diagnosis of stroke, though there was significant heterogeneity in this estimate. The five most frequent non-stroke diagnoses were seizure, syncope, sepsis, migraine and brain tumours.
  
  
  CONCLUSIONS
  Patients who had not had a stroke accounted for a significant proportion of people referred to stroke services. Expertise in the differential diagnoses of stroke is needed in order to manage the patients at the point of referral.
authors.affiliation: Department of Clinical Radiology, Western General Hospital, Edinburgh EH4 2XU, UK. lornagibson1@nhs.net
authors.forename: L M
authors.initials: LM
authors.lastname: Gibson
authors.forename: W
authors.initials: W
authors.lastname: Whiteley
mesh_terms: D002983:Clinical Competence; D003937:Diagnosis, Differential; D006268:Health Facilities; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care; D012017:Referral and Consultation; D020521:Stroke / Q000175:diagnosis*
keywords: Stroke; diagnosis; epidemiology; systematic review