A Person with Factitious Disorder Presenting with Acute Stroke-Like Symptoms and Receiving Thrombolytic Therapy Twice
|Samir R Belagaje*, Jordan Bonomo, Christopher White, Brett Kissela, Dawn Kleindorfer, Robert Neel and Joseph Broderick|
|Grady Memorial Hospital, Atlanta, GA 30303, United States|
|Corresponding Author :||Samir R Belagaje
Faculty Office Building #375
Grady Memorial Hospital
80 Jesse Hill Jr Dr. SE
Atlanta, GA 30303, United States
E-mail: [email protected]
|Received March 15, 2012; Accepted April 23, 2012; Published May 02, 2012|
|Citation: Belagaje SR, Bonomo J, White C, Kissela B, Kleindorfer D, et al. (2012) A Person with Factitious Disorder Presenting with Acute Stroke-Like Symptoms and Receiving Thrombolytic Therapy Twice. J Clin Case Rep 2:138. doi:10.4172/2165-7920.1000138|
|Copyright: © 2012 Belagaje SR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
One of the challenges in acute stroke management is accurately differentiating between actual ischemic events and other conditions that mimic stroke. In a cohort of 821 consecutive patients admitted to an acute stroke unit, 13% were incorrectly diagnosed as stroke . In another cohort of 411 patients, it was estimated that 19% of patients presenting to the emergency department with stroke-like symptoms ultimately have other diagnoses such as a postictal state, metabolic disturbances, and systemic infections . Regardless of the actual percentage, it is clear that not all cases of acute stroke-like symptoms are true strokes and other mimics should be considered. One such mimic is factitious disorder.
Factitious disorder is a psychiatric condition in which afflicted individuals exaggerate symptoms and even endorse medical illness, or psychological trauma in order to draw attention or sympathy to themselves. The DSM-IV criteria for this disorder are: 1) Intentional production or feigning of physical or psychological signs or symptoms; 2) The motivation for the behavior is to assume the sick role; and 3)
External incentives for the behavior such as economic gain or avoiding legal responsibility as seen in malingering, are absent .
Here, we present a case of a patient who was diagnosed with factitious disorder after he presented to two different institutions with acute stroke-like symptoms and received tissue plasminogen activator
(t-PA) twice within the span of 3 weeks.