Discrepancies between clinical and autopsy findings in patients who had an acute stroke

Objectives According to international observations,the incidence of clinical autopsies is declining worldwide,plummeting below 5%in the USA and many European countries.It is an unfavourable trend as,in 7%-12%of cases,recent clinicopathological studies found discrepancies that might have changed the therapy or the outcome if known premortem.As previous large-scale observations have examined varied patient populations,we aimed to focus on the differences between the clinical and pathological diagnostic findings in only patients who had a stroke.Material and methods We assessed the postmortem non-neuropathological and neuropathological findings of 534 consecutive patients who had a stroke who passed away.Systemic neoplasms,pneumonias,thromboembolisms and haemorrhagic transformations revealed only by autopsy were considered severe abnormalities;in addition,benign abnormalities important from an educational or scientific point of view were also recorded.Results In 26 of the 534 cases(4.9%),the presence of systemic neoplasms had already been confirmed in the clinical stage;however,8(1.5%)malignant tumours were only detected during autopsy.Also,80(15%)thromboembolic events,73(13.6%)pneumonias and 66(18%)haemorrhagic transformations were only diagnosed at autopsy.Longer hospital stay(from admission to death)resulted in fewer discrepancies between clinical and autopsy diagnosis of thromboembolic events and pneumonias(p<0.01).In 169 cases,benign findings were detected.Conclusions While the type of acute stroke is reliably diagnosed with imaging techniques,postmortem autopsies are also important in patients who had a stroke as autopsies may reveal clinically silent diseases(eg,tumour),and contribute to knowing the actual incidence of stroke-related thromboembolic and pneumonia complications.