PURPOSE OF REVIEW: Munchausen syndrome by tissue plasminogen activator (tPA) is a phenomenon we describe as patients exhibiting factitious symptoms to assume the role of the sick patient, desiring and received tPA, with no alternative diagnosis or secondary gain to better account for their presentation. To illustrate this phenomenon and its magnitude, we present a series of cases of Munchausen syndrome by tPA, prevalence in our stroke center, and highlight one illustrative case. RECENT FINDINGS: Of 335 cases with tPA administration over 29 months, 10 were confirmed as Munchausen syndrome by tPA, reflecting a 3.0% prevalence in our stroke center. SUMMARY: Munchausen syndrome by tPA is an underappreciated phenomenon encountered in evaluating patients with acute stroke symptoms. Administering tPA in Munchausen syndrome poses an ethical dilemma because standard of care favors rapid tPA administration, but administration can cause harm, burdens the healthcare system, and does not treat the patient's Munchausen syndrome.
PURPOSE OF REVIEW: Munchausen syndrome by tissue plasminogen activator (tPA) is a phenomenon we describe as patients exhibiting factitious symptoms to assume the role of the sick patient, desiring and received tPA, with no alternative diagnosis or secondary gain to better account for their presentation. To illustrate this phenomenon and its magnitude, we present a series of cases of Munchausen syndrome by tPA, prevalence in our stroke center, and highlight one illustrative case. RECENT FINDINGS: Of 335 cases with tPA administration over 29 months, 10 were confirmed as Munchausen syndrome by tPA, reflecting a 3.0% prevalence in our stroke center. SUMMARY: Munchausen syndrome by tPA is an underappreciated phenomenon encountered in evaluating patients with acute stroke symptoms. Administering tPA in Munchausen syndrome poses an ethical dilemma because standard of care favors rapid tPA administration, but administration can cause harm, burdens the healthcare system, and does not treat the patient's Munchausen syndrome.
Authors: Georgios Tsivgoulis; Ramin Zand; Aristeidis H Katsanos; Nitin Goyal; Ken Uchino; Jason Chang; Efthimios Dardiotis; Jukka Putaala; Anne W Alexandrov; Marc D Malkoff; Andrei V Alexandrov Journal: Stroke Date: 2015-03-19 Impact factor: 7.914
Authors: Marta Guillan; Araceli Alonso-Canovas; Jaime Gonzalez-Valcarcel; Nuria Garcia Barragan; Juan Garcia Caldentey; Ignacio Hernandez-Medrano; Alicia Defelipe-Mimbrera; Victor Sanchez-Gonzalez; Elena Terecoasa; Maria Alonso de Leciñana; Jaime Masjuan Journal: Cerebrovasc Dis Date: 2012-07-31 Impact factor: 2.762
Authors: Jeffrey L Saver; Gregg C Fonarow; Eric E Smith; Mathew J Reeves; Maria V Grau-Sepulveda; Wenqin Pan; Daiwai M Olson; Adrian F Hernandez; Eric D Peterson; Lee H Schwamm Journal: JAMA Date: 2013-06-19 Impact factor: 56.272