Intravenous Thrombolysis for a Stroke Mimic Patient

The authors present the case of a young woman on phentermine and herbal supplements who presented as an acute stroke alert with right-sided facial droop and numbness. She was treated acutely with intravenous tissue plasminogen activator (tPA). However, the workup did not reveal any evidence of cerebrovascular disease or cerebral infarct. The authors discuss plausible stroke mimics and the safety of administering tPA to such patients.

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Stroke Mimics and Acute Stroke Evaluation: Clinical Differentiation and Complications after Intravenous Tissue Plasminogen Activator

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.12.072 ◽

2015 ◽

Vol 49 (2) ◽

pp. 244-252 ◽

Cited By ~ 22

Author(s):

Peggy L. Nguyen ◽

Jason J. Chang

Keyword(s):

Acute Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Stroke Mimics ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen

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The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study)

International Journal of Stroke ◽

10.1177/1747493019840932 ◽

2019 ◽

Vol 14 (7) ◽

pp. 752-755 ◽

Cited By ~ 10

Author(s):

Kentaro Suzuki ◽

Kazumi Kimura ◽

Masataka Takeuchi ◽

Masafumi Morimoto ◽

Ryuzaburo Kanazawa ◽

...

Keyword(s):

Acute Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Endovascular Therapy ◽

Randomized Study ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Bridging Therapy ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen

Rationale Bridging therapy with endovascular therapy (EVT) and intravenous thrombolysis (IVT) has been reported to improve outcomes for acute stroke patients with large-vessel occlusion in the anterior circulation. While the IVT may increase the reperfusion rate, the risk of hemorrhagic complications increases. Whether EVT without IVT (direct EVT) is equally effective as bridging therapy in acute stroke remains unclear. Aim This randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator for acute stroke with ICA and M1 occlusion aims to clarify the efficacy and safety of direct EVT compared with bridging therapy. Methods and design This is an investigator-initiated, multicenter, prospective, randomized, open-treatment, blinded-endpoint clinical trial. The target patient number is 200, comprising 100 patients receiving direct EVT and 100 receiving bridging therapy. Study outcome The primary efficacy endpoint is a modified Rankin Scale score of 0–2 at 90 days. Safety outcome measures are any intracranial hemorrhage at 24 h. Discussion This trial may help determine whether direct EVT should be recommended as a routine clinical strategy for ischemic stroke patients within 4.5 h from onset. Direct EVT would then become the choice of therapy in stroke centers with endovascular facilities. Trial registration UMIN000021488.

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Validation of FLAIR Hyperintense Lesions as Imaging Biomarkers to Predict the Outcome of Acute Stroke after Intra-Arterial Thrombolysis following Intravenous Tissue Plasminogen Activator

Cerebrovascular Diseases ◽

10.1159/000350201 ◽

2013 ◽

Vol 35 (5) ◽

pp. 461-468 ◽

Cited By ~ 9

Author(s):

Jong-Won Chung ◽

Kyeong Joon Kim ◽

Won-Young Noh ◽

Myung Suk Jang ◽

Mi Hwa Yang ◽

...

Keyword(s):

Acute Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Imaging Biomarkers ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Arterial Thrombolysis

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Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽

10.1161/str.48.suppl_1.wp72 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lila E Sheikhi ◽

Stacey Winners ◽

Pravin George ◽

Andrew Russman ◽

Zeshaun Khawaja ◽

...

Keyword(s):

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Stroke Unit ◽

Early Experience ◽

Final Diagnosis ◽

Stroke Mimics ◽

Intravenous Tissue Plasminogen Activator ◽

Mobile Stroke Unit ◽

Tissue Plasminogen ◽

Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

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