A Person with Factitious Disorder Presenting with Acute Stroke-Like Symptoms and Receiving Thrombolytic Therapy Twice

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 [1]. 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 [2]. 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.