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Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

Authors Rico M, Martinez-Rodriguez L, Larrosa-Campo D, Calleja S

Received 21 November 2015

Accepted for publication 16 February 2016

Published 11 June 2016 Volume 2016:9 Pages 145—148


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas

María Rico, Laura Martinez-Rodriguez, Davinia Larrosa-Campo, Sergio Calleja

Neurology Department, Central University Hospital of Asturias, Oviedo, Spain

Background: Stroke mimics may account for up to 30% of all acute stroke consultations. However, in the emergency setting, accurate diagnosis is not always possible.
Methods: Case report and review of the literature.
Results: A 73-year-old woman was admitted to the emergency department with acute aphasia and right hemiparesis. The National Institute of Health Stroke Score was 21, compatible with severe stroke, so she received thrombolysis. Laboratory testing demonstrated severe hypomagnesemia. She had been taking proton pump inhibitors for years and neuroimaging did not demonstrate signs of acute ischemic disease. After correcting the metabolic alterations with intravenous and oral supplemental magnesium, the patient was discharged asymptomatic. No further episodes have been registered to date.
Conclusion: Hypomagnesemia might cause acute neurological symptoms that could be confused with stroke. A careful history is essential for diagnosis but suspicion of stroke mimic should not prevent tPA administration.

hypomagnesemia, stroke mimic, aphasia, stroke

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