Research Day
SQUAMOUS CELL CARCINOMA OF THE NECK: AN UNLIKELY STROKE MIMIC
Document Type
Abstract
Date
2021
Abstract
Background: Stroke is one of the leading causes of morbidity and mortality in the United States. For patients presenting to the emergency department (ED) with stroke symptoms, physicians must rapidly evaluate for stroke in order to initiate appropriate treatment and avoid long term disability of patients. However 30% of cases presenting to the (ED) with acute onset of neurological deficits are due to stroke mimics.
Case History: An 87-year-old man with a sixty-year smoking history, chronic obstructive pulmonary disease, and extensive cardiovascular disease history presented to the ED with lower back pain, right rib pain, and new onset right arm weakness. Due to the classical stroke symptoms and risk factors, stroke was suspected. Computed tomography (CT) of the head excluded hemorrhage or mass lesion. A CT angiography of the head and neck revealed a large mass compressing the right subclavian artery and right brachial plexus. A subsequent CT scan of the chest, abdomen, and pelvis revealed masses on the pubic ramus, iliac bone and several vertebral bodies. Biopsy of the rib mass revealed squamous cell carcinoma.
Discussion: Even in high-paced settings, clinicians must maintain a high index of suspicion for stroke mimics. A thorough patient history and physical exam, differentiating between peripheral and central symptoms, can help to distinguish between stroke and stroke mimics. This case illustrates the vital importance of neuroimaging in the diagnosis of stroke and in the case of our patient, his stroke mimic.