Stroke Mimics and Intravenous Thrombolysis - 16/12/11
, Jukka Putaala, MD, PhD a, Daniel Strbian, MD, PhD a, Atte Meretoja, MD a, Katja Piironen, MD a, Ron Liebkind, MD, PhD a, Heli Silvennoinen, MD, PhD b, Sari Atula, MD, PhD a, Olli Häppölä, MD, PhD aHelsinki Stroke Thrombolysis Registry Group
Address for correspondence: Ville Artto, MD, PhDRésumé |
Study objective |
The necessity for rapid administration of intravenous thrombolysis in patients with acute ischemic stroke may lead to treatment of patients with conditions mimicking stroke. We analyze stroke patients treated with intravenous thrombolysis in our center to characterize cases classified as stroke mimics.
Methods |
We identified and reviewed all cases with a diagnosis other than ischemic stroke in our large-scale single-center stroke thrombolysis registry. We compared these stroke mimics with patients with neuroimaging-negative and neuroimaging-positive ischemic stroke results.
Results |
Among 985 consecutive intravenous thrombolysis–treated patients, we found 14 stroke mimics (1.4%; 95% confidence interval 0.8% to 2.4%), 694 (70.5%) patients with neuroimaging-positive ischemic stroke results, and 275 (27.9%) patients with neuroimaging-negative ischemic stroke results. Stroke mimics were younger than patients with neuroimaging-negative or -positive ischemic stroke results. Compared with patients with neuroimaging-positive ischemic stroke results, stroke mimics had less severe symptoms at baseline and better 3-month outcome. No differences appeared in medical history or clinical features between stroke mimics and patients with neuroimaging-negative ischemic stroke results. None of the stroke mimics developed symptomatic intracerebral hemorrhage compared with 63 (9.1%) among patients with neuroimaging-positive ischemic stroke results and 6 (2.2%) among patients with neuroimaging-negative ischemic stroke results.
Conclusion |
Stroke mimics were infrequent among intravenous thrombolysis–treated stroke patients in this cohort, and their treatment did not lead to harmful complications.
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| Supervising editors: Steven M. Green, MD; Michael L. Callaham, MD |
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| Author contributions: VA, JP, and DS contributed equally to the work. All authors contributed to writing and editing of the article and approval of the final version, study concept and planning, interpretation of the literature, and data acquisition. VA, JP, DS, AM, KP, RL, SA, and OH were responsible for the literature search. VA had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. OH was responsible for logistic and administrative support. VA takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Meretoja received honoraria for speaking in educational symposia in 2008 and 2009 and for consulting in 2010 from Boehringer Ingelheim, European manufacturer of tPA. Dr. Häppölä received honoraria for speaking in educational symposia in 2008 through 2010. Helsinki University Central Hospital (EVO) funded the study. |
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| Publication date: Available online October 14, 2011. |
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| A podcast for this article is available at www.annemergmed.com. |
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| Please see page 28 for the Editor's Capsule Summary of this article. |
Vol 59 - N° 1
P. 27-32 - janvier 2012 Retour au numéro
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