Stroke Mimics and Chameleons from the Radiological Viewpoint of Glioma Diagnosis

  • SASAGAWA Ayaka
    Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • MIKAMI Takeshi
    Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • KIMURA Yusuke
    Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • AKIYAMA Yukinori
    Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • SUGITA Shintaro
    Department of Surgical Pathology, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • HASEGAWA Tadashi
    Department of Surgical Pathology, Sapporo Medical University, Sapporo, Hokkaido, Japan
  • WANIBUCHI Masahiko
    Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
  • MIKUNI Nobuhiro
    Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan

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<p>Gliomas are sometimes difficult to differentiate from strokes and are often misdiagnosed on magnetic resonance imaging (MRI); thus, the terms “stroke mimics” and “stroke chameleons” have been introduced. In this study, we analyzed stroke mimics and stroke chameleons in glioma and discussed the diagnostic perplexity.</p><p>We retrospectively reviewed cases that were removed from lesions that were considered to be brain tumors. This study enrolled 214 patients who underwent tumor resection for suspected glioma. Clinical characteristics and radiological findings of the patients were compared between the masquerade findings group, which was further divided into two groups: the stroke chameleons and stroke mimics according to their final diagnosis, and the intelligible findings group.</p><p>Stroke chameleons and stroke mimics were significantly higher in age and smaller in lesion size than the intelligible findings group. In the multivariate analysis, the predictive factor of the masquerade finding group was higher age and smaller size. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different.</p><p>Proper diagnosis of glioma and stroke affects a patient’s prognosis, and should be diagnosed as soon as possible. However, stroke mimics and stroke chameleons caused by glioma can occur. Thus, the diagnosis of a stroke should take into consideration the possibility of a glioma in real clinical situations.</p>

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