BACKGROUND AND PURPOSE: Intravenous thrombolysis for acute ischemic stroke is usually based on clinical assessment, blood test results, and CT findings. Intravenous thrombolysis of stroke mimics may occur but has not been studied in detail. METHODS: We determined frequency, clinical characteristics, and outcome of mimic patients versus patients with stroke treated with intravenous thrombolysis using data of a prospective, single-center thrombolysis data bank. RESULTS: Among 250 patients, 243 (97.2%) had strokes and 7 (2.8%) were mimics. Seizure was the most frequent diagnosis among mimics. There was a trend toward lower National Institutes of Health Stroke Scale scores in mimics (9.9+/-4.2) compared with strokes (13.7+/-5.4; P=0.06). Global aphasia without hemiparesis was the presenting symptom in 3 (42.9%) mimics versus 8 (3.3%) strokes (P=0.002). Orolingual angioedema, symptomatic intracranial hemorrhage, and asymptomatic intracranial hemorrhage occurred in 3 (1.2%), 13 (5.3%), and 30 (12.3%) patients with stroke, but were absent in mimics. After 3 months, 6 (85.7%) mimics and 86 (35.4%) strokes had a modified Rankin Scale score of 0 to 1 (P=0.01). CONCLUSIONS: Only few patients receiving intravenous thrombolysis did eventually have a final diagnosis other than stroke, ie, mostly seizures. Their outcome was favorable. Although clinical features differed between the stroke and the mimic groups, the differences were not distinctive enough to allow assigning individual patients to either of the groups. Multimodal neuroimaging or electroencephalographic recordings may be helpful for this assignment. However, their potential benefit has to be weighed against the potential harm of delayed thrombolysis.
BACKGROUND AND PURPOSE: Intravenous thrombolysis for acute ischemic stroke is usually based on clinical assessment, blood test results, and CT findings. Intravenous thrombolysis of stroke mimics may occur but has not been studied in detail. METHODS: We determined frequency, clinical characteristics, and outcome of mimic patients versus patients with stroke treated with intravenous thrombolysis using data of a prospective, single-center thrombolysis data bank. RESULTS: Among 250 patients, 243 (97.2%) had strokes and 7 (2.8%) were mimics. Seizure was the most frequent diagnosis among mimics. There was a trend toward lower National Institutes of Health Stroke Scale scores in mimics (9.9+/-4.2) compared with strokes (13.7+/-5.4; P=0.06). Global aphasia without hemiparesis was the presenting symptom in 3 (42.9%) mimics versus 8 (3.3%) strokes (P=0.002). Orolingual angioedema, symptomatic intracranial hemorrhage, and asymptomatic intracranial hemorrhage occurred in 3 (1.2%), 13 (5.3%), and 30 (12.3%) patients with stroke, but were absent in mimics. After 3 months, 6 (85.7%) mimics and 86 (35.4%) strokes had a modified Rankin Scale score of 0 to 1 (P=0.01). CONCLUSIONS: Only few patients receiving intravenous thrombolysis did eventually have a final diagnosis other than stroke, ie, mostly seizures. Their outcome was favorable. Although clinical features differed between the stroke and the mimic groups, the differences were not distinctive enough to allow assigning individual patients to either of the groups. Multimodal neuroimaging or electroencephalographic recordings may be helpful for this assignment. However, their potential benefit has to be weighed against the potential harm of delayed thrombolysis.
Authors: Nuria García Barragán; Marta Guillán; Beatriz Zarza; Cristina González-Gordaliza; Alicia de Felipe Mimbrera; María Alonso de Leciñana; Jaime Masjuan Journal: J Neurol Date: 2012-02-09 Impact factor: 4.849
Authors: Matthew B Maas; Michael H Lev; Hakan Ay; Aneesh B Singhal; David M Greer; Wade S Smith; Gordon J Harris; Elkan F Halpern; Walter J Koroshetz; Karen L Furie Journal: J Stroke Cerebrovasc Dis Date: 2010-12-24 Impact factor: 2.136
Authors: O Y Chernyshev; S Martin-Schild; K C Albright; A Barreto; V Misra; I Acosta; J C Grotta; S I Savitz Journal: Neurology Date: 2010-03-24 Impact factor: 9.910
Authors: Jessalyn K Holodinsky; Tyler S Williamson; Andrew M Demchuk; Henry Zhao; Luke Zhu; Michael J Francis; Mayank Goyal; Michael D Hill; Noreen Kamal Journal: JAMA Neurol Date: 2018-12-01 Impact factor: 18.302
Authors: Syed F Ali; Gordian J Hubert; Jeffrey A Switzer; Jennifer J Majersik; Roland Backhaus; L Wylie Shepard; Kishore Vedala; Lee H Schwamm Journal: Stroke Date: 2018-01-26 Impact factor: 7.914