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Implementing Diagnostic Reasoning to Differentiate Todd's Paralysis From Acute Ischemic Stroke

Brosinski, Carmen M. MSN, LCDR, NC, USN

Advanced Emergency Nursing Journal: January/March 2014 - Volume 36 - Issue 1 - p 78–86
doi: 10.1097/TME.0000000000000007
Cases of Note

Emergency department clinicians with limited resources are relied upon to deliver safe and timely patient care. Clinicians rely on cognitive biases such as anchoring, availability, and premature closure based on experience and quick mental algorithms to streamline medical data and arrive at a diagnosis. Although this is a time-saving and efficient method in the management of uncomplicated illnesses, it can result in a wrong diagnosis when managing patients with complicated presentations such as a stroke or a stroke mimic. Two conditions that present similarly, making it difficult to differentiate between them, are Todd's paralysis (a stroke mimic seen in selected patients with epilepsy) and acute ischemic stroke. However, by clinical reasoning, clinicians can formulate an accurate diagnosis while avoiding diagnostic biases. Incorporating clinical reasoning into the diagnostic process consists of gathering pertinent data, performing a diagnostic time-out, and arriving at a diagnosis reflective of data findings.

Emergency Department, Naval Hospital Guam, Agana Heights.

Corresponding Author: Carmen M. Brosinski, MSN, LCDR, NC, USN, Emergency Department, Naval Hospital Guam, Bldg 1, Farenholt Ave, Agana Heights, GU 96910 (

The reviews expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of Navy, Department of Defense, or the U.S. Government.

C. M. B. is a military service member. This work was prepared as a part of his official duties. Title 17, USC, 105 provides that Copyright protection under this title is not available for any work of the U.S. Government. Title 17, USC, 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.

Disclosure: The author reports no conflicts of interest.

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