Stroke mimics: Clinical characteristics and outcome

BackgroundStroke mimics (SM) are non-stroke conditions producing similar symptoms to stroke. Prehospital stroke identification tools prioritise sensitivity over specificity, therefore >25% of prehospital suspected stroke patients are SM. Failure to identify SM Results in inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool for paramedics, using information often available in the prehospital setting, to identify SM amongst suspected stroke patients.MethodsThe initial tool was developed using a systematic literature review to identify SM characteristics, a survey of UK paramedics to explore the acceptability of SM identification and regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to their primary hospital diagnoses (n=1,650, 40% SM).The initial tool was refined using two focus groups with paramedics (n=3) and hospital clinicians (n=9) and analysis of an expanded prehospital dataset (n=3,797, 41% SM) to produce the final STEAM tool.ResultsSTEAM scores six variables:1 point for Systolic blood pressure <90 mmHg1 point for Temperature >38.5°C with heart rate >90 bpm1 point for seizures or 2 points for seizures with diagnosed Epilepsy1 point for Age <40 years or 2 points for age <30 years1 point for headache with diagnosed Migraine1 point for FAST–veA score of ≥2 on STEAM predicted SM diagnosis in the expanded derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. STEAM was validated using an external dataset (n=1,848, 33% SM) of prehospital suspected stroke patients where STEAM was 5.5% sensitive, 99.4% specific with a PPV of 82.5%.ConclusionsSTEAM uses common clinical characteristics to identify a small number of SM patients with a high level of certainty. The benefits of reducing SM admissions to specialist stroke services should be weighed against delayed admission for the small number of stroke patients identified as a SM.

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Abstract WP104: Clinical Characteristics of Stroke Mimics Treated on an Urban Mobile Stroke Unit

Stroke ◽

10.1161/str.50.suppl_1.wp104 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Michael P Lerario ◽

Benjamin R Kummer ◽

Xian Wu ◽

Iván Diáz ◽

Sammy Pishanidar ◽

...

Keyword(s):

Stroke Unit ◽

Clinical Characteristics ◽

Stroke Mimics ◽

Mobile Stroke Unit

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Abstract 105: Impact of the Extended Window Mechanical Thrombectomy on Tele Stroke Call Volume in the Post-DAWN and DEFUSE -3 Era

Stroke ◽

10.1161/str.51.suppl_1.105 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sami Al Kasab ◽

Eyad Almallouhi ◽

Line Abdul Rahman ◽

Michael Nahhas ◽

Jillian Harvey ◽

...

Keyword(s):

Symptom Onset ◽

Clinical Characteristics ◽

Mechanical Thrombectomy ◽

Time Window ◽

The United States ◽

Controlled Trials ◽

Stroke Mimics ◽

Randomized Controlled ◽

Number Of Patients ◽

Before And After

Introduction: Recently, two randomized controlled trials proved the safety and efficacy of mechanical thrombectomy in patients presenting up to 24 hours from symptom onset. While the number of patients receiving mechanical thrombectomy has increased following the publication of the extended time window trials, the literature on acute stroke calls over telestroke is relatively scant. In this study we evaluate the volume of telestroke calls, rate of transfers to the thrombectomy center and MT receipt before and after the extended window MT trials publication. Methods: We interrogated the prospectively collected data from a major telestroke network in Southeast the United States to include patients who received a telestroke consult between January 2015 and July 2019. We compared the demographical and clinical characteristics and the outcomes between patients who presented before and after the publication of the extended window mechanical thrombectomy trials. Results: Total of 7,438 patients were evaluated during the study period. Of those, 3392 were after February 2018. There was no difference in age, race, or sex between the two groups (table 1). Patients in the post extended window group had lower National Institute of Health stroke scale (NIHSS) on presentation (3 vs. 4, P<0.001), had longer symptom-onset to door time (123 vs. 85 min, P<0.001), and were more likely to present with stroke mimics (41% vs. 35.3%, P<0.001).Despite this increase in the number of consults per month (190 vs. 103, P<0.001) in the post-DAWN era, there was similar rates of patients eventually receiving MT (3.9% vs. 3.8%, p=0.849) Conclusion: The number of telestroke consults almost doubled since the publication of the extended thrombectomy trials without increase in the rate of MT receipt. These findings have important operational implications for hospitals implementing telestroke call coverage.

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Stroke mimics: Clinical characteristics and outcome

Neurosciences ◽

10.17712/nsj.2020.1.20190096 ◽

2020 ◽

Vol 25 (1) ◽

pp. 38-42 ◽

Cited By ~ 1

Author(s):

Ali Al Khathaami ◽

Sultan Alsaif ◽

Bayan Al Bdah ◽

Muath Alhasson ◽

Mohammed Aldriweesh ◽

...

Keyword(s):

Clinical Characteristics ◽

Stroke Mimics

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Clinical Characteristics of Stroke Mimics Presenting to a Stroke Center within the Therapeutic Window of Thrombolysis

Brain & Neurorehabilitation ◽

10.12786/bn.2018.11.e9 ◽

2018 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Mohammed Mahgoub Yahia ◽

Shahid Bashir

Keyword(s):

Clinical Characteristics ◽

Therapeutic Window ◽

Stroke Mimics ◽

Stroke Center

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Abstract WP71: Intravenous Thrombolysis in Stroke-mimics: Is There a Relationship With Door-to-needle Time?

Stroke ◽

10.1161/str.48.suppl_1.wp71 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Elisa Campos-Costa ◽

Carmen Labandeira-Guerra ◽

Cristina Martínez-Reglero ◽

Sandra Boned ◽

Maria Muchada ◽

...

Keyword(s):

Clinical Characteristics ◽

Ct Perfusion ◽

Intravenous Thrombolysis ◽

Treatment Decision ◽

Final Diagnosis ◽

Neurological Deficits ◽

Stroke Patients ◽

Stroke Mimics ◽

Contrast Ct ◽

Iv Tpa

Introduction: Several non-vascular conditions may mimic the sudden neurological deficits of stroke (stroke mimics, SM). In Stroke Code, time to treatment is crucial, but the efforts to increase the benefits of iv-tPA may lead to inadvertent treatment of SM. We aim to determine the relationship between door-to-needle (DTN) time and SM treatment. Methods: Retrospective analysis of all acute stroke patients treated with iv-tPA included in an institutional prospective database. SM were identified during follow-up and their clinical characteristics compared with the confirmed stroke patients in the same time-period. Results: During a 3-year period, 332 thrombolysed patients were included. Twenty-two were SM (6.6%, 95%CI:4.0%-9.3%), with median age of 58 years (range 35-87), 54.5% were men, median NIHSS=10 (range 3-30). Sudden (81.8%) neurological deficits were motor in 11 patients (52.2%), altered speech in 10 (47.6%) and sensitive in 7 (33.3%). Baseline clinical characteristics (including age, sex, vascular risk factors and initial NIHSS) were similar between stroke and SM groups. Multimodal imaging was used for treatment decision in 95.5% of SM (CT-perfusion 10 patients, CT-angiography 9, MRI 1 and only 1 patient received just non-contrast CT) vs 74.1% of confirmed strokes (p=0.014). Four SM patients presented with neuroimaging abnormalities. DTN of SM was similar to those of strokes (35.5 VS. 40minutes, p=0.6). Despite a progressive decrease in median DTN time (year 1: 47min vs year 3: 36min; p=0.02) the rate of SM treated with tPA did not increase (year 1: 5.4% vs 9% in year 3; p=0.1). No intracranial haemorrhage or other complications were recorded in any SM patient. At discharge, 86.4% of SM presented a modified Rankin Scale 0-1. The most frequent final diagnosis were: migraine (31.8%), functional symptoms (27.3%) and seizures (27.3%). Conclusions: Despite multimodal neuroimaging, stat differentiation between SM and stroke is still difficult. Reduction of DTN times may not necessarily increase the number of SM thrombolysed. Nevertheless, iv-tPA revealed to be safe in SM and should not be delayed in case of doubt.

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