title: Parkinsonism or Other Movement Disorders Presenting as Stroke Mimics.
abstract: OBJECTIVE
  Patients with parkinsonism or other movement disorders may visit the emergency department due to acute deterioration of neurological status or consciousness disturbance. Under such circumstances, patients may be misdiagnosed as having a hyperacute stroke, i.e. stroke mimic. The purpose of the present study was to explore the clinical features and consequences of patients with parkinsonism or other movement disorders presenting as stroke mimics with activation of a stroke code.
  
  
  METHODS
  In this retrospective case-series study, we reviewed the charts and stroke code registry data in two stroke centers with high volume of stroke codes and thrombolytic therapy in the Southern Taiwan.
  
  
  RESULTS
  We found seven male patients (67.0 ± 12.8 years old): one with focal myoclonus, one with focal dystonia, and the other five with parkinsonism. The chief problems for emergency department visit included acute consciousness disturbance in one patient and motor weakness in other six patients. Five of the six patients with motor weakness complained unilateral symptoms. Six patients were evaluated by neurology residents (five by second-year residents, one by a third-year resident) and one by a board-certified neurologist, while a misdiagnosis of a stroke was made in three patients. All patients experienced neurological improvement when follow-up. One patient who received intravenous thrombolytic therapy had no intracranial hemorrhagic complications.
  
  
  CONCLUSIONS
  Although rare, parkinsonism or other movement disorders may present as a stroke mimic with activation of a stroke code. Consulting neurologists should clarify the etiology for those patients with acute consciousness disturbance or motor weakness and avoid unnecessary thrombolysis. Key Words: Parkinson disease, parkinsonism, movement disorders, stroke code, thrombolysis.
authors.affiliation: Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
authors.forename: Sheng-Feng
authors.initials: SF
authors.lastname: Sung
authors.affiliation: Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Wen-Juh
authors.initials: WJ
authors.lastname: Hwang
mesh_terms: D000368:Aged; D003244:Consciousness Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis; D020734:Parkinsonian Disorders / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*