A new study from Claggett, Sykes & Garza reveals a dangerous and underreported crisis in emergency medicine: strokes are being misdiagnosed at alarming rates, particularly when patients present with non-traditional symptoms like dizziness or vertigo.
Despite public perception that stroke symptoms are always obvious, slurred speech, facial drooping, or limb weakness, the reality is far more complex. The firm’s legal-medical team reviewed audits from hospitals nationwide and found that up to 40% of stroke cases involving dizziness are misdiagnosed in the ER. Many of these patients are discharged with a diagnosis of “benign vertigo” only to return within hours or days with catastrophic brain damage or death.
“We expect our emergency rooms to catch life-threatening conditions like stroke, but when symptoms aren’t textbook, patients are falling through the cracks,” said a spokesperson for Claggett, Sykes & Garza. “This is a systemic issue-driven by outdated triage protocols, missed diagnostic opportunities, and built-in biases.”
Key Findings from the 2024-2025 Emergency Stroke Audit Report:
40% of stroke patients presenting with dizziness or vertigo are initially misdiagnosed
35% of those misdiagnosed are discharged without appropriate imaging, leading to death or permanent injury within 72 hours
Posterior circulation strokes-which impact balance and coordination-are 5x more likely to be missed
Only 18% of ER clinicians use the HINTS test, a low-cost eye exam proven to outperform early MRIs in detecting subtle strokes
An estimated 12,800 preventable stroke deaths occur each year in the U.S. due to diagnostic delays
Women, young adults, and Black patients face significantly higher odds of delayed or incorrect stroke diagnosis
Disparities and Missed Diagnoses by Group:
| Presentation Type | Misdiagnosis Rate | Discharged Without Imaging | Mortality Increase |
|---|---|---|---|
| Dizziness/Vertigo Only | 40% | 35% | 2.4x |
| Posterior Stroke | 37% | 28% | 3.0x |
| Women Under 50 (Atypical Symptoms) | 31% | 22% | 2.1x |
| Minor Stroke (NIHSS < 5) | 27% | 19% | 1.8x |
| CT Only (No MRI Follow-Up) | 29% | 25% | 2.2x |
| No Neurologist at Triage | 33% | 30% | 3.5x |
| Black Patients (Non-Classic Symptoms) | 36% | 32% | 2.6x |
| ERs Without HINTS Protocol | 39% | 34% | 2.9x |
The Hidden Stroke Symptoms Putting Lives at Risk:
Dizziness & Vertigo: Routinely mistaken for inner ear issues, these symptoms are red flags for posterior strokes, yet often misdiagnosed.
Posterior Circulation Strokes: Affecting the brainstem and cerebellum, these strokes are subtler but deadlier when missed.
Atypical Symptoms in Women: Headache, fatigue, and anxiety-like symptoms are frequently dismissed, leading to delayed care.
Minor Strokes: Low NIH Stroke Scale scores don’t guarantee safety-these can still cause severe cognitive or sensory impairment.
Reliance on CT Scans Alone: Early CT scans often miss posterior strokes, yet many hospitals fail to follow up with an MRI.
Lack of Neurology Coverage: ERs without neurology support are at a severe disadvantage in catching complex stroke cases.
Bias in Triage: Black patients and young adults face diagnostic disparities when presenting with non-classic symptoms.
Stroke Symptoms Are Not Always Obvious-But the Consequences Are
“Time lost is brain lost,” the spokesperson emphasized. “The public needs to understand that symptoms like dizziness, nausea, vision problems, or imbalance may signal a stroke in progress. When ERs dismiss these signs, it costs lives.”
Methodology
The firm’s analysis includes data from 14 peer-reviewed studies, national hospital audits, and over 25,000 ER stroke triage cases between 2023 and 2025. Sources include the American Heart Association, Johns Hopkins, NIH Stroke Scale studies, and federal datasets from AHRQ and PSNet. The report also evaluates diagnostic tool usage (e.g., the HINTS test), disparities by race and gender, and the link between discharge decisions and 72-hour outcomes.
