scholarly journals Acute SARS‐CoV‐2 infection and reversible splenial hyperintensity: A stroke mimic

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Thomas Mathew ◽  
Saji K. John ◽  
Sharath Kumar G. G.
Keyword(s):  
Stroke Mimic

scholarly journals Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2480-2487
Author(s):  
Salvatore Rudilosso ◽  
Alejandro Rodríguez ◽  
Sergio Amaro ◽  
Víctor Obach ◽  
Arturo Renú ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Predictive Value ◽  
Brain Perfusion ◽  
Complete Recovery ◽  
Vascular Perfusion ◽  
Computed Tomography Perfusion ◽  
Stroke Mimic ◽  
Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

Abstract 14767: Thrombolysis of Stroke Mimics via Telestroke

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ravyn Howell ◽  
Randheer S Yadav ◽  
Sushil Lakhani ◽  
Sharon Heaton ◽  
Karen L Wiles ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
National Institutes Of Health ◽  
Factitious Disorder ◽  
Emergency Rooms ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Stroke Diagnosis ◽  
History Of ◽  
Stroke Mimic ◽  
Similar Episode

Introduction: Telestroke allows stroke expertise for thrombolysis decision making remotely using high-quality bidirectional audiovisual technology. Hypothesis: Intravenous tissue plasminogen activator (IVtPA) is administered via telestroke network to a proportion of patients without a stroke diagnosis (i.e. stroke mimic) Methods: Our academic comprehensive stroke program telestroke program includes 26 spoke Emergency rooms (ERs) through which IVtPA is administered throughout central Ohio. From July 1, 2016 to Sept 30, 2017, nearly all patients who received IVtPA at the outside hospital telestroke ERs were transferred to our institution for post-IVtPA care. Data was collected on final diagnosis, demographics, National Institutes of Health Stroke Scale (NIHSS), door to needle (DTN) time, and outcomes. Results: Among 270 acute ischemic stroke patients who received IVtPA via telestroke, we identified 64 (23.7%) with a stroke mimic diagnosis. Stroke mimics were younger (mean age 56.4 vs 68.2, p <0.0001), more likely female (60.9% vs 45.6%, p 0.03), and had higher DTN times (85.3 vs 69.9 minutes, p 0.0008). The increase in DTN was due to longer time to recommend by the telestroke neurologist for stroke mimic (65.0 vs 53.2 minutes, p 0.0034). The stroke mimic diagnosis included Migraine 26 (40.6%), Factitious disorder 12 (18.8%), Encephalopathy 7 (10.9%), and Unmasking 6 (9.4%). The stroke mimics did not differ from each other based upon initial NIHSS, DTN, or sex. Compared to the other stroke mimics, Migraine and Factitious disorder patients were younger (51.2 vs 63.9 years, p <0.0006), more likely to have a personal history of migraines (42.1% vs 0%, p < 0.0001), and more likely to have functional exam findings (42.1% vs 3.8%, p 0.0007). There were no hemorrhagic complications in the stroke mimic patients. Among all stroke mimics, 26 (40.6%) had a history of similar prior episodes and 10 (15.6%) would have future recurrence of another similar episode, with 2 patients receiving IVtPA again in the future (1 Migraine and 1 Factitious disorder). Conclusions: In a tertiary academic telestroke network, nearly one-quarter of patients receive IVtPA for a non-stroke diagnosis, with migraine and factitious disorder being the most commonly seen.

scholarly journals Acute Vertigo with Double Vision – Brainstem Stroke or Stroke Mimic?

2010 ◽  
Vol 30 (6) ◽  
pp. 626-627 ◽  
Author(s):  
Regina Schlaeger ◽  
Yvonne Naegelin ◽  
Antje Welge-Lüssen ◽  
Dominik Straumann ◽  
Achim Gass ◽  
...  
Keyword(s):  
Double Vision ◽  
Brainstem Stroke ◽  
Stroke Mimic

An unusual stroke mimic

BMJ ◽  
2018 ◽  
pp. k3642
Author(s):  
Ashley Smith ◽  
Adarsh Aravind
Keyword(s):  
Stroke Mimic

Abstract WP277: Race Score is Scalable to Other Ems Systems; A Sensitivity Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sharjeel Panjwani ◽  
Julie Shawver ◽  
Syed F Zaidi ◽  
Mouhammad A Jumaa
Keyword(s):  
Hospital Setting ◽  
Arterial Occlusion ◽  
Final Diagnosis ◽  
Medical Emergency ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Spanish Study ◽  
Back Ground ◽  
Stroke Mimic ◽  
Lucas County

Back Ground: Rapid Arterial Occlusion Evaluation Scale (RACE) was first instituted in Barcelona and described in 2014 to successfully assess stroke severity and identify patients with acute stroke with large vessel occlusion (LVO) at pre-hospital setting by medical emergency technicians. Objective: We instituted Rapid Arterial Occlusion Evaluation Scale (RACE) hospital bypass protocol (RA) in Lucas county, Ohio since July 2015. Our aim in this study is to evaluate the sensitivity of our RACE protocol in identifying cerebro-vascular accidents and furthermore to identify ischemic CVAs from the cohort. Method: All county EMS personnel (N=464) underwent training in the Rapid Arterial Occlusion Evaluation (RACE) score. The RACE Alert (RA) protocol, whereby patients with stroke symptoms, who were last seen normal less than 12 hours and had a RACE score ≥5 were taken to a facility that has neuro-interventional capacity, was implemented in July 2015. An IRB approved prospective DB was maintained during that period. Patient’s stroke characteristics, type of acute treatment and final diagnosis on discharge were reviewed for the purpose of this abstract. Our results were comparable to the Spanish study done in Barcelona in 2014. Results: Between Jul 2016-Jun 2016 186 RAs were activated. The discharge diagnoses included ischemic stroke N=91 (49%), ICH N=26 (14%) and TIA N=17(9%). The rate of stroke mimic was N=52 (28%) of the total RACE alerts. These included seizures (12%), metabolic encephalotpathy (12%) and others including sepsis and migraines. Of the patients presenting as RA, 33% underwent IV tPA treatment ± mechanical thrombectomy. Conclusion: Results from our prospective county wide data is comparable to prior studies. RACE score may be scalable to other EMS systems to triage potential LVOs for direct transfer to centers with interventional capabilities.

Abstract TP99: Human Lung Endothelial Cell Anti-Inflammatory and Regenerative Responses in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nikunj Satani ◽  
Kaavya Giridhar ◽  
Natalia Wewior ◽  
Dominique D Norris ◽  
Scott D Olson ◽  
...  
Keyword(s):  
Gene Expression ◽  
Endothelial Cells ◽  
Inflammatory Responses ◽  
Inflammatory Factors ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anti Inflammatory ◽  
Lung Endothelial Cells ◽  
Stroke Mimic

Background: Inflammatory responses after stroke consists of central and peripheral immune responses. The role of the spleen after stroke is well-known, however the role of the lungs has not been studied in detail. We explored the relation between stroke severity and immunomodulatory changes in lung endothelial cells. Methods: Human pulmonary endothelial cells (hPECs, Cell Biologics) were cultured at passage 3. Serum from stroke patients with NIH Stroke Scale (NIHSS) severity ranging from 0 to 20 was collected at 24 hours after stroke. hPECs were exposed to media with 1) 10% FBS alone (N=6), 2) 10% serum from stroke patients (N=72), or 3) 10% serum from stroke mimic patients (N=6). After 3 hour of exposure, fresh media was added and secretomes from hPECs were measured after 24 hours. We isolated RNA from hPECs after 3 hour of serum exposure and measured gene expression (N=6 for each group). Secretome and gene changes in hPECs were analyzed based on stroke severity, tPA treatment, and co-morbidities. Results: Serum from stroke patients reduced the secretion of IL-8, MCP-1 and Fractalkine (p<0.01), and increased the secretion of VEGF and BDNF (p<0.01) from hPECs. These effects were more pronounced depending on stroke severity (Fig). There was no effect of tPA or T2DM on hPECs secretomes. There was significantly reduced gene expression of IL-6, IL-8, MCP-1 and IL-1β and significantly higher expression of ICAM1, IGF-1 and TGF-β1 as compared to stroke mimics. Conclusion: Exposure of hPECs to serum from stroke patients alters their immunomodulatory properties. Higher severity of stroke leads to more protective response from hPECs by reducing the secretion of pro-inflammatory factors, while increasing the secretion of anti-inflammatory factors.

Abstract 157: A Streamlined Hyperacute MRI Protocol Identifies IV tPA-Eligible Stroke Patients When Initial Clinical Assessment Favors Stroke Mimic

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Manu Goyal ◽  
Brian Hoff ◽  
Jennifer A Williams ◽  
Joshua Buck ◽  
Laura Heitsch ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Symptom Improvement ◽  
Start Time ◽  
Patient Transport ◽  
Discharge Outcomes ◽  
Mri Protocol ◽  
Discharge Location ◽  
Pressure Symptom ◽  
Stroke Mimic ◽  
Iv Tpa

Background: The possibility of a stroke mimic (SM) challenges the initial clinical assessment of patients presenting with suspected acute ischemic stroke (AIS). When SM is deemed likely, IV tPA may be withheld, risking an opportunity to treat an AIS. Though not routinely used in the hyperacute setting, MRI may help in diagnosing stroke when SM is favored but not certain. We hypothesized that a streamlined, hyperacute MRI (HMRI) protocol would identify a small, but important, group of IV tPA-eligible AIS patients among those initially favored to have SM. Methods: A streamlined HMRI protocol was designed based on several identified barriers to rapid patient transport, MR image acquisition, and post-MRI tPA delivery. Treating neurologists were trained to only order HMRI when SM was favored and IV tPA was being withheld (Fig). Use of HMRI for tPA decision-making, as well as baseline variables, door-to-needle times (DNT), and discharge outcomes were compared before HMRI implementation (“Pre-HMRI”: 8/1/2011-7/31/2013) and after (“Post-HMRI”: 8/1/13-7/31/14). Results: Post-HMRI, 53 patients with suspected SM, who were otherwise IV tPA eligible, underwent HMRI (median MRI order to start time 29 min). Seven of 53 patients (13%) were subsequently diagnosed with AIS based on HMRI, of whom 4 received IV tPA; 3 were excluded from IV tPA due to blood pressure, symptom improvement, and change in last known normal time. Pre-HMRI, 158 patients were treated with IV tPA, of whom none received IV tPA aided by HMRI. Post-HMRI, 80 patients were treated with IV tPA, of whom 4 patients (5%) were treated with IV tPA utilizing HMRI results (0 vs 5%, p=0.012). In pre- and post-HMRI IV tPA-treated patients, DNT (39 vs 37 min, p=0.95), symptomatic hemorrhage rate (5 vs 2%, p=0.28), and favorable discharge location (85 vs 90%, p=0.32) did not differ. Conclusions: A streamlined HMRI protocol permitted IV tPA administration to a small, but significant, subset of AIS patients initially deemed to have a SM.

Abstract NS6: Born to Run: Advanced Practice Provider-Led Mobile Stroke Unit Care Measures Up to Vascular Neurologists’ Diagnosis and Management

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne W Alexandrov ◽  
Wendy Dusenbury ◽  
Victoria Swatzell ◽  
Joseph Rike ◽  
Andrew Bouche ◽  
...  
Keyword(s):  
Medical Diagnosis ◽  
Treatment Decisions ◽  
Diagnosis And Treatment ◽  
Advanced Practice ◽  
Treatment Delivery ◽  
Stroke Treatment ◽  
Diagnosis And Management ◽  
Mobile Stroke Unit ◽  
Stroke Mimic ◽  
Treatment Safety

Background: Mobile Stroke Units (MSU) are growing in numbers throughout the U.S. and abroad, with numerous staffing configurations, telemedicine, and differing imaging capabilities. We aimed to test the diagnostic accuracy and treatment safety, alongside time to diagnosis and treatment delivery of a novel advanced practice provider (APP) led MSU team. Methods: We launched an MSU housing a hospital-grade Siemens Somatom CT with CTA capabilities, and hired APPs with advanced neurovascular practitioner board certification to lead field medical diagnosis and order/initiate treatment for encountered stroke patients. Consecutive MSU patients were evaluated for differences between APPs and Vascular Neurologists (VNs) diagnosis and management, and scene diagnosis and treatment times were collected. Results: Agreement between APP field medical diagnosis and MD hospital diagnosis was 100%; stroke mimic diagnosis agreement was 98%. Overall agreement for field interpretation of CT/CTA was 97%, with discrepancies not associated with stroke treatment decisions. MDs’ agreement with APPs’ identification/treatment of ICH was 100%, and IVtPA treatment decisions 98% (APPs more conservative). Scene arrival to medical diagnosis (including clinical exam and imaging completion/interpretation) ranged from 7-10 minutes, of which 4 minutes were CT/CTA start to finish times. Scene arrival to IVtPA bolus ranged from 16 minutes to 33 minutes and was driven primarily by need for control of excessive hypertension, with scene arrival to start of nicardipine premix infusion ranging from 10-14 minutes. Conclusions: Use of an APP-led MSU is safe and non-inferior to VN diagnosis/management, and may be faster than telemedicine guided MSU treatment.

Abstract P404: Causes of Recrudescent Stroke Symptoms in Emergent Stroke Evaluations

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Quinn ◽  
Mohammad Hajighasemi ◽  
Laurie Paletz ◽  
Sonia Figueroa ◽  
Konrad Schlick
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Ischemic Lesion ◽  
Tertiary Care Medical Center ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Rule Out

Introduction: Recrudescent symptoms of remote central nervous system lesions (primarily due to prior ischemic or hemorrhagic stroke) is a specific stroke mimic that is commonly in the differential diagnosis in patients presenting for emergent stroke evaluation. To date, best practices have yet to be established in terms of ensuring accurate diagnosis and the relative rates of causative systemic illnesses are not well described. We seek to better delineate the etiologies of recrudescent stroke symptoms seen at a tertiary care medical center via emergency stroke evaluation “Code Brain” (CB) as a first step towards clarifying diagnostic criteria for this entity. Methods: Data was obtained via retrospective chart review from consecutive patients via departmental database listing all CB consults seen at a tertiary care comprehensive stroke center in Los Angeles, California between the timeframe of January 2018- June 2020. Diagnoses for each case were adjudicated by faculty Vascular neurologists, in collaboration with Vascular neurology fellows and Neurology residents. Those cases with a diagnosis of stroke recrudescence were reviewed in detail for the extent of neuroimaging they underwent, as well as for identified causes of recrudescence. Results: Records of 3,998 consecutive CB activations were reviewed. 2.1% (n=85) were found after screening to have clinical diagnosis of recrudescence or chronic stroke. Of these 85 patients, 29.4% (n=25) were not found to have a causative etiology for recrudescent neurologic deficit. Of these 25 patients, 36.0% (n=9) did not undergo MRI to evaluate for interval ischemic lesion, as compared to 46.6% of those whom a causative etiology was identified. This difference (10.6%, 95% CI -12.30 to 30.67%, p=0.3719) was not significant. Discussion: At our comprehensive stroke center, recrudescent stroke is an uncommon diagnosis amongst all CB evaluations, despite being commonly considered. Despite a diagnosis of recrudescence, MRI brain is not always performed to rule out acute ischemic stroke. Standardized neuroimaging protocols should be considered in making the diagnosis of stroke recrudescence.

Abstract WP386: tPA Treatment for Patients Found to Have Stroke Mimic is Similar Among Neurovascular Fellows and Attendings

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Ali Kerro ◽  
Chunyan Cai ◽  
Christy Ankrom ◽  
Arvind Bambhroliya ◽  
Rene Malazarte ◽  
...  
Keyword(s):  
Stroke Mimic
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