Introduction Differentiating between acute stroke and stroke mimics remains a significant challenge. In factitious disorder, a patient intentionally produces physical symptoms to obtain attention or treatment. We present such a case, in a patient who has been thrombolysed for stroke at least 4 times and has had a multitude of neuroimaging. Case A 41-year-old gentleman presented in March 2016 with acute onset left facial droop, left arm and leg weakness, NIHSS 5. His past medical history included asthma, type 2 diabetes and epilepsy. He was given IV thrombolysis. He was subsequently recognised by the stroke clinical nurse specialist from an admission the previous year under a different name. He left the ward abruptly with apparent complete resolution of his neurological deficits. His admission in 2015 had been similar: NIHSS 6, received IV thrombolysis with rapid resolution of symptoms. On both admissions, all neuroimaging was normal. Review of imaging from 35 Irish hospitals, on the National Integrated Medical Imaging System, revealed multiple previous similar presentations. Between 2010 and 2016, he had 46 CT brains, 5 CT angiograms, 7 MRI brains across 13 hospitals and was thrombolysed on at least 4 occasions.This is likely an underestimate as he has previously used an assumed name and self-reports thrombolysis in the UK. Conclusion Factitious disorder is a challenging differential diagnosis for stroke. Given the time constraints on administering thrombolysis and reliance on clinical diagnosis, communication between stroke physicians on a national level is important to identify cases such as these, in order to limit unnecessary treatment and investigation.
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