EMR Chapter 25-MCIT-F3-1207 | Stroke Chameleons : 

This course is designed for EMRs to recognize strokes that present in subtle and atypical ways, often mistaken for other conditions. This chapter discusses identifying hidden stroke symptoms, applying advanced assessment techniques,  improving decision making during patient-care, and SBAR communication format. The lessons covered are 

• Lesson 1: Recognizing The Hidden Signs of Stroke Chameleons
• Lesson 2: Identifying Atypical Presentations
• Lesson 3: Advanced EMR Assessment Techniques
• Lesson 4: Communication, Triage, And Scenarios

Excerpt from EMR Chapter 25-MCIT-F3-1207 | Stroke Chameleons : 

The minor symptoms chameleon might be the most frustrating because everyone, including the patient, minimizes it. “My face feels a little funny but it’s probably nothing.” “I’m just having trouble finding the right words because I’m tired.” These patients often don’t want to go to the hospital because the symptoms seem too minor. But here’s the reality – minor strokes are still strokes, and they’re often warnings of a massive stroke coming soon. Up to 20% of patients with “minor” strokes will have a major stroke within 90 days, many within the first 48 hours.

TIAs (transient ischemic attacks) where symptoms completely resolve are equally dangerous – they’re literally the brain’s warning system firing. Your assessment might find subtle things the patient hasn’t noticed. Check facial symmetry carefully – have them show their teeth, raise their eyebrows, and puff their cheeks.

For arm drift, have them close eyes and hold arms out for a full 10 seconds – subtle drift or pronation (palm turning down) is significant. Listen to their speech – are they substituting words, having word-finding difficulty, or just sounding “off” according to family?