Journal of Clinical Case Reports

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

Abstract

Samir R Belagaje, Jordan Bonomo, Christopher White, Brett Kissela, Dawn Kleindorfer, Robert Neel and Joseph Broderick

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.
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 [3].
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.