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

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammed Mahgoub Yahia ◽  
Shahid Bashir
Keyword(s):  
Clinical Characteristics ◽  
Therapeutic Window ◽  
Stroke Mimics ◽  
Stroke Center

STROKE MIMICS: A PSYCHOGENIC STROKE PATIENT TREATED WITH ALTEPLASE

2019 ◽  
Vol 17 (1) ◽  
pp. 97-102
Author(s):  
Dariusz Kotlęga ◽  
Barbara Peda ◽  
Tomasz Trochanowski ◽  
Monika Gołąb-Janowska ◽  
Sylwester Ciećwież ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Conversion Disorder ◽  
Initial Diagnosis ◽  
Therapeutic Window ◽  
Stroke Mimics ◽  
Conversion Disorders ◽  
Proper Diagnosis ◽  
Intravenous Alteplase ◽  
The Subject ◽  
Stroke Mimic

For rtPA treatment to be effective it should be initiated within the first 4.5 hours following the onset of a stroke. Such a short therapeutic window demands a rapid diagnosis and decision making on the part of the physician. There are patients with stroke-like symptoms and an initial diagnosis of a stroke, but who are finally diagnosed as suffering from another condition. According to the subject literature, stroke mimics are diagnosed in about 1.4 – 3.5% of patients initially diagnosed as having had an ischemic stroke. Psychogenic strokes (conversion disorders) may be found in as many as 8.2% of stroke patients. Proper diagnosis is especially important in patients eligible for thrombolytic treatment when there is usually not enough time to establish the diagnosis of a stroke mimic, especially one of psychogenic origin. A patient with an initial diagnosis of an ischemic stroke who was treated with intravenous alteplase infusion. The previous two ischemic strokes treated in the same manner had been diagnosed one and two years earlier. In all hospitalizations no rtPA treatment complications had been observed. In our patient a proper neuropsychological examination was performed and a conversion disorder diagnosed. We would like to underline the importance of cooperation between the neuropsychologist and neurology physician within clinical practice.

scholarly journals 01 Development and validation of a pragmatic prehospital tool to identify stroke MIMIC patients

2019 ◽  
Vol 36 (1) ◽  
pp. e1.1-e1
Author(s):  
Graham McClelland ◽  
Darren Flynn ◽  
Helen Rodgers ◽  
Chris Price
Keyword(s):  
Clinical Characteristics ◽  
List Type ◽  
Stroke Patients ◽  
Stroke Mimics ◽  
Primary Hospital ◽  
Stroke Services ◽  
Suspected Stroke ◽  
Stroke Mimic ◽  
High Level ◽  
Development And Validation

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.

Abstract WP238: Thrombolytic Use in Stroke Mimics via Telestroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Michael A Sperl ◽  
Aditi Gupta ◽  
Jayashree Ravichandran ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Rehabilitation Unit ◽  
Stroke Mimics ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Acute Rehabilitation

Background: It has been established that safety and outcomes of intravenous thrombolysis (IVT) to stroke patients via telestroke (TS) is similar to those presenting to stroke centers. Little is known on the accuracy of TS diagnosis among those receiving IVT. We sought to compare the rate of stroke mimic (SM) patients receiving IVT in our TS network to those who present to our comprehensive stroke center (CSC). Methods: Consecutive patients receiving IVT between August 2014 and June 2015 were identified at our CSC and TS network. The rates of SM patients in each cohort were calculated. Outcomes measured included rates of symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and discharge to home or an acute rehabilitation unit (ARU). Results: During the study period, 132 patients (mean age 71±15 years, 49% women) receiving IVT were included in the analysis (75 CSC, 57 TS). Rates of SM patients receiving IVT were similar (CSC 12% vs TS 7%, p=0.39). One stroke patient developed sICH, and three other stroke patients experienced in-hospital mortality; neither outcome was found in the SM cohort. Discharge to home or ARU was similar between stroke (76.5%) and SM (76.9%) patients (p=1). Patients with SMs had significantly higher diagnoses of migraine (p=0.045) and psychiatric disorders (p=0.0002) compared to stroke patients. Conclusion: The rate of IVT among SM patients via TS is low and similar to those who present directly to a stroke center. Continued efforts should be made to further minimize IVT in SM patients despite the low rate of complications.

Abstract WP238: Safety and Outcomes of Stroke Mimics After Thrombolysis: A Single Center Experience

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kathleen Mays-Wilson ◽  
Patricia Penstone ◽  
Daniel Miller ◽  
Panayiotis D Mitsias ◽  
Christopher A Lewandowski
Keyword(s):  
Treatment Time ◽  
Tertiary Care ◽  
Conversion Disorder ◽  
Bleeding Complications ◽  
Published Data ◽  
Care Hospital ◽  
Stroke Mimics ◽  
Single Center Experience ◽  
Primary Stroke Center ◽  
Stroke Center

Background: Administration of intravenous (IV) t-PA for acute ischemic stroke (AIS) improves outcomes. The most dreaded complication is intracerebral hemorrhage (ICH). Some patients have symptoms that impersonate an AIS but are later found to have an alternate diagnosis; these are termed stroke mimics (SM). SM treated with IV t-PA are exposed to hemorrhagic complications without benefit. Objectives: To describe the characteristics, safety, and outcomes of SM patients treated with t-PA under 4.5 hours. Methods: We reviewed all patients hospitalized after IV t-PA treatment at a tertiary care hospital and primary stroke center from January 2008 through December 2011. SMs were determined by review of clinical and imaging findings. SM are described and compared to t-PA treated patients with AIS for demographics, ICH, bleeding complications, and outcomes. Results: We identified 38 SM (12%) and 285 AIS (88%) t-PA treated patients. Compared to AIS, SM patients were younger (55.1 vs. 67.0 yrs, p<.001), more often women (68% vs.49%, p=.025), and reported a history of stroke more often (45% v 14%, p<.001). There were no differences in race, baseline stroke scale (9.4 v 10.9, p=.26), or onset to treatment time (164 min v 159 min, p=.63); 12 SM were in the 3-4.5 hour window. There were no ICHs or deaths in SM patients. There were two (5.2%) SM systemic hemorrhages; a femoral artery bleed post cardiac catheterization requiring transfusion, and an UGI bleed after a nasogastric tube not requiring transfusion. The average SM length of stay was 3.4 +/- 2.2 days. The mean discharge NIHSS score was 1.3 +/-2.5 in the SM v 4.6+/-5.7 in the AIS patients (p<.001). SM discharges were: home (84%), rehab center (12%), Nursing home 3%, and other (3%). The most common cause of SM was conversion disorder (47%) seizures (32 %) and migraine (8%). Conclusion: SM are not uncommon. Treatment of SM with IV t-PA appears to be safe in this cohort. The most common etiologies of stroke mimics were conversion disorder, seizures, and migraine. These results are consistent with existing published data on use of IV t-PA in SMs. Until more specific diagnostics are available, suspected SM should not be a reason to withhold t-PA treatment.

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

Stroke ◽  
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

Abstract TP300: Is Stroke Code Activation for Stroke Mimics Decreasing With Stroke Center Certification

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Julian Duda ◽  
Syed F Ali ◽  
Brett Meyer ◽  
Dawn Meyer
Keyword(s):  
Stroke Mimics ◽  
Stroke Center

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

Stroke ◽  
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.

scholarly journals Shortening time to reperfusion after transfer from a primary to a comprehensive stroke center

2019 ◽  
Vol 9 (5) ◽  
pp. 417-423 ◽  
Author(s):  
Denis Sablot ◽  
Geoffroy Farouil ◽  
Alexandre Laverdure ◽  
Caroline Arquizan ◽  
Alain Bonafe
Keyword(s):  
Clinical Characteristics ◽  
Mechanical Thrombectomy ◽  
High Volume ◽  
Reperfusion Therapy ◽  
Mri Imaging ◽  
Interhospital Transfer ◽  
Primary Stroke Center ◽  
Speed Up ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BackgroundThis study assessed whether a quality improvement (QI) process to streamline transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) could reduce the delay of reperfusion by mechanical thrombectomy (MT).MethodsFrom 2015 to 2017, a QI process was implemented with specific interventions to reduce door-in-to-door-out (DIDO) time in a high volume PSC, and speed up interhospital transfer and inhospital processes at the CSC. Clinical characteristics and time metrics were compared in the QI (2015–2017; n = 157) and pre-QI cohorts (2012–2014; n = 121).ResultsDuring the QI process, the median symptom onset to reperfusion time was reduced by 50 minutes (367 vs 417 minutes in the pre-QI cohort, p < 0.04), with a substantial 40-minute DIDO reduction (78 vs 118 minutes, p < 0.01), related to the faster administration of IV thrombolysis (median door-to-needle time: 49 vs 82 minutes, p = 0.0001). The door-to-door time was shortened (170 vs 205 minutes, p = 0.002), but not the transfer time (92 vs 87 minutes, p = 0.5). The QI process had no effect on the prehospital phase (77 vs 76 minutes, p = 0.83) and on the time from MRI imaging at the PSC to reperfusion (252 vs 288 minutes, p = 0.12). The rate of modified Rankin Scale score 0–2 at 90 days was comparable in the pre-QI and QI cohorts.ConclusionsA QI process can reduce the reperfusion therapy delay in a distant CSC; however, we could not demonstrate that it can also improve the outcome of patients who undergo MT.

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