scholarly journals Meningioma: An Important Stroke Mimic

2021 ◽  
pp. 47
Author(s):  
Seng Wee Cheo ◽  
Tee Tat Khoo ◽  
Qin Jian Low ◽  
Yuen Kang Chia
Keyword(s):  
Facial Asymmetry ◽  
Clinical Problem ◽  
Haemorrhagic Stroke ◽  
Sudden Onset ◽  
Left Middle Cerebral Artery ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Stroke Mimics ◽  
Stroke Mimic ◽  
Toast Classification

Rapid Stroke is a common clinical problem. Stroke can be broadly divided into ischaemic and haemorrhagic stroke. Ischaemic stroke can be further classified by TOAST classification into large-artery atherosclerosis, cardioembolism, small vessel occlusion, the stroke of other determined aetiology and stroke of undetermined aetiology. Importantly, we need to be wary of important stroke mimics such as brain tumour, demyelination, intoxication as they can lead to changes in clinical management. Here, we would like to illustrate a case of meningioma which clinically mimics a stroke. This patient is a 78-year-old lady who initially presented with sudden onset right-sided body weakness associated with slurred speech and facial asymmetry. An urgent plain computed tomography (CT) of the brain showed hypodensities at the left middle cerebral artery territory. However, re-evaluation noted her to have a normal Glasgow Coma Scale without any cortical signs, cerebellar sign or dysphasia. In view of these, stroke mimics was suspected. A contrasted CT brain was done which confirmed the diagnosis of meningioma. She was offered surgical intervention for meningioma but she was not keen on it. In conclusion, this case highlighted the importance of clinical evaluation in recognising stroke mimics.

scholarly journals Relationship between stroke etiologies and clinical manifestations/Oxfordshire

2021 ◽  
Author(s):  
Silas Paulo Lima de Souza ◽  
Antonio Carlos Dias Andrade ◽  
Vinicius Leal Borges da Cruz ◽  
João Paste ◽  
Tiago Timotio de Almeida ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Manifestations ◽  
Cross Sectional Study ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Cross Sectional ◽  
Reference Hospital ◽  
Toast Classification

Introduction: The classification of strokes subtypes is important, since they have different management and prognoses. This study aims to verify associations between the etiologies of the stroke according to the TOAST classification and the clinical presentation by the subtypes of the Oxfordshire scale. Methods: A descriptive cross-sectional study, with patients admitted to a stroke unit of a reference hospital in Salvador-BA between 11/2017 and 03/2020. We included patients over 18 years of age and didn’t include patients with inaccuracies in the filling of medical records or who didn’t meet the criteria for admission to the cohort. Results: 300 patients between 25 and 98 years old (mean: 64 years; SD: 13.34) were analyzed. Regarding cardioembolic etiology (CE), 34 patients (45.3%) had lacunar syndromes (LACS) and 25 (33.3%) Partial Anterior Circulation Syndrome (PACS). Patients with Large Artery Atherosclerosis (LAA) 24 (40.7%) had PACS while 21 (35.6%) of the LACS patients diagnosed with small vessel occlusion (SVO) 22 (62.9%) had LACS. Futhermore, patients with cryptogenic strokes (CS) had predominantly PACS and LACS, 27 (31%) and 40 (46%) respectively. Conclusion: Based on the results of acute strokes of CE, SVO and CS origin are related to LACS. The events originated by LAA are more associated with PACS. Events caused by SVO were related to lacunar syndromes, corroborating with findings in the literature.

034 The susceptibility vessel sign: a clinical-radiological case of propagating left MCA thrombus with resolving neurological deficits

2018 ◽  
Vol 89 (6) ◽  
pp. A14.2-A14
Author(s):  
Benjamin Nham ◽  
Simon Hawke
Keyword(s):  
Sudden Onset ◽  
Neurological Deficits ◽  
Left Middle Cerebral Artery ◽  
List Type ◽  
Radiological Sign ◽  
Vessel Occlusion ◽  
Ct Angiogram ◽  
Gradient Echo Imaging ◽  
Haemoglobin Content ◽  
Left Middle

IntroductionThe susceptibility vessel sign (SVS) is a radiological sign on the SWI sequence of MRI that can predict cardioembolic source and increased recanalisation rates in stroke.1 We present a case of an 86 year old female with resolving neurological deficits from a propagating left MCA thrombus with positive SVS on imaging.CaseAn 86 year old female presented with sudden onset right sided weakness and expressive aphasia in the context of new atrial fibrillation. Her NIHSS was 4. Initial CT angiogram showed complete occlusion of the proximal M1 segment of the left middle cerebral artery. She was within the thrombolysis window but her deficits largely resolved (NHISS 0) before thrombolysis could be administered. A repeat CT angiogram one hour after the first scan showed complete resolution of the MCA occlusion. An MRI brain showed curvilinear gradient signal hypointensity in the distal left M2 segment of the MCA (positive SVS) with a small area of infarction and restricted diffusion. She was discharged on apixaban without neurological deficit. This is a unique case of a stroke patient, with proximal large vessel occlusion, presenting with neurological deficits that self-resolved within minutes without thrombolysis or thrombectomy. There was a positive SVS on MRI. This radiological sign allows direct visualisation of the hypointense thrombo-embolus on the SWI sequence. It occurs as there is a higher level of deoxy-haemoglobin content in the thrombo-embolus and is predictive of a cardioembolic source as cardioembolic thrombi are rich in erythrocytes1.ConclusionOur case demonstrated interesting clinical-radiological-pathological correlation in cardioembolic stroke with resolving neurological deficits. The patient’s clinical improvement matched the radiological improvement and corresponded to the pathophysiological course of thrombus from embolization, propagation, occlusion, dissolution and then recanalisation. The SVS is a useful radiological sign to predict cardioembolic sources of stroke and is associated with higher vessel re-canalisation rates.Reference. Cho KH, Kim JS, Kwon SU, et al. Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke2005;36:2379–2383.

Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients

2018 ◽  
Vol 14 (4) ◽  
pp. 400-408 ◽  
Author(s):  
Frederik Geisler ◽  
Syed F Ali ◽  
Martin Ebinger ◽  
Alexander Kunz ◽  
Michal Rozanski ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Characteristic Curve ◽  
Hospital Setting ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Stroke Mimics ◽  
Mobile Stroke Unit ◽  
Stroke Mimic

Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany. We investigated whether the TM-score (comprising six parameters), Face Arm Speech Time test, and individual patient characteristics were able to differentiate cerebrovascular disease from stroke mimic patients. Results We included 423 patients (299 (70.7%) cerebrovascular disease and 124 (29.3%) stroke mimic) in the final analysis. A TM-score > 30 indicated a high probability of a cerebrovascular disease and a score ≤15 of a stroke mimic. The TM-score performed well to identify stroke mimics (area under the curve of 0.74 under receiver-operating characteristic curve analysis). The cerebrovascular disease patients were older (74.8 vs. 69.8 years, p = 0.001), had more often severe strokes (NIHSS > 14 25.8% vs. 11.3%, p = 0.001), presented more often with weakness of the face (70.9% vs. 42.7%, p = 0.001) or arm (60.9% vs. 33.9%, p = 0.001), dysarthria (59.5% vs. 40.3%, p < 0.001), history of atrial fibrillation (38.1% vs. 21.0%, p = 0.001), arterial hypertension (78.9% vs. 53.2%, p < 0.001), and less often with seizure (0.7% vs. 21.0%, p < 0.001). Conclusions The TM-score and certain patient characteristics can help paramedics and emergency physicians in the field to identify stroke mimic patients and select the most appropriate hospital destination.

Abstract TP227: Vascular Calcification, Atherosclerosis Burden, and Stroke Mechanism in Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takashi Shimoyama ◽  
Kunio Nakamura ◽  
Sibaji Gaj ◽  
Shivakrishna Kovi ◽  
Ken Uchino
Keyword(s):  
Ischemic Stroke ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Stroke Subtypes ◽  
Toast Classification ◽  
Stroke Mechanism ◽  
Post Hoc

Background and Purpose: Calcification of the intracranial carotid artery is recognized as a risk factor for stroke in the general population. The significance of vascular calcifications in its relationship stroke mechanisms is incompletely understood. We hypothesized that vascular calcium quantification using CT angiography (CTA) can differ by stroke mechanism among ischemic stroke patients. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who underwent CTA. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Stroke subtypes were diagnosed based on the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism (CE), others/undetermined. We evaluated the relationship between CTA calcification volume and stroke subtypes on one-way ANOVA and Tukey’s post-hoc test. Results: Of the 558 consecutive acute ischemic stroke patients, we enrolled 388 patients (212 males; mean age 66.6 years) in the study. Others/undetermined (34.8%) was the most frequent stroke subtype, followed by CE (29.4%), LAA (25.5%), and SVO (10.3%). The overall prevalence of atherosclerotic calcification was 95.9% in stroke patients. LAA had significantly higher calcification volume with 809 mm 3 compared to SVO (390 mm 3 , P=0.040), others/undetermined (300 mm 3 , P=0.001), but not CE (860 mm 3 , P=0.958). In age < 65 years subset, LAA showed higher calcification volume with 567 mm 3 than SVO (176 mm 3 , P=0.014), CE (213 mm 3 , P=0.021) and others/undetermined (180 mm 3 , P<0.001). There were no significant differences in calcification volume among stroke subtypes in age ≥65 years. Conclusion: Atherosclerotic calcium burden with a quantitative analysis of CTA images may be useful to differentiate stroke mechanism in younger patients.

scholarly journals Endovascular therapy in patients with large vessel occlusion due to cardioembolism versus large-artery atherosclerosis

2021 ◽  
Vol 14 ◽  
pp. 175628642199901
Author(s):  
Meredeth Zotter ◽  
Eike I. Piechowiak ◽  
Rupashani Balasubramaniam ◽  
Rascha Von Martial ◽  
Kotryna Genceviciute ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endovascular Therapy ◽  
Independent Predictor ◽  
Intravenous Thrombolysis ◽  
Stent Retriever ◽  
Large Vessel ◽  
Large Artery ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Background and aims: To investigate whether stroke aetiology affects outcome in patients with acute ischaemic stroke who undergo endovascular therapy. Methods: We retrospectively analysed patients from the Bernese Stroke Centre Registry (January 2010–September 2018), with acute large vessel occlusion in the anterior circulation due to cardioembolism or large-artery atherosclerosis, treated with endovascular therapy (±intravenous thrombolysis). Results: The study included 850 patients (median age 77.4 years, 49.3% female, 80.1% with cardioembolism). Compared with those with large-artery atherosclerosis, patients with cardioembolism were older, more often female, and more likely to have a history of hypercholesterolaemia, atrial fibrillation, current smoking (each p < 0.0001) and higher median National Institutes of Health Stroke Scale (NIHSS) scores on admission ( p = 0.030). They were more frequently treated with stent retrievers ( p = 0.007), but the median number of stent retriever attempts was lower ( p = 0.016) and fewer had permanent stent placements ( p ⩽ 0.004). Univariable analysis showed that patients with cardioembolism had worse 3-month survival [72.7% versus 84%, odds ratio (OR) = 0.51; p = 0.004] and modified Rankin scale (mRS) score shift ( p = 0.043) and higher rates of post-interventional heart failure (33.5% versus 18.5%, OR = 2.22; p < 0.0001), but better modified thrombolysis in cerebral infarction (mTICI) score shift ( p = 0.025). Excellent (mRS = 0–1) 3-month outcome, successful reperfusion (mTICI = 2b–3), symptomatic intracranial haemorrhage and Updated Charlson Comorbidity Index were similar between groups. Propensity-matched analysis found no statistically significant difference in outcome between stroke aetiology groups. Stroke aetiology was not an independent predictor of favourable mRS score shift, but lower admission NIHSS score, younger age and independence pre-stroke were (each p < 0.0001). Stroke aetiology was not an independent predictor of heart failure, but older age, admission antithrombotics and dependence pre-stroke were (each ⩽0.027). Stroke aetiology was not an independent predictor of favourable mTICI score shift, but application of stent retriever and no permanent intracranial stent placement were (each ⩽0.044). Conclusion: We suggest prospective studies to further elucidate differences in reperfusion and outcome between patients with cardioembolism and large-artery atherosclerosis.

Evaluation of Factors Associated With Elevated Levels of Platelet-Derived Microparticles in the Acute Phase of Cerebral Infarction

2009 ◽  
Vol 16 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Nagato Kuriyama ◽  
Yoshinari Nagakane ◽  
Akiko Hosomi ◽  
Tomoyuki Ohara ◽  
Takashi Kasai ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Acute Phase ◽  
Control Level ◽  
Intima Media Thickness ◽  
Vascular Lesions ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Atherosclerotic Lesions

Background: Platelet-derived microparticles (PDMPs) have attracted attention as blood coagulation-promoting, endothelial cell-activating factors. The objective of this study was to determine the parameters associated with elevated PDMP levels and examine their relationship with atherosclerotic lesions of main intracranial and extracranial arteries. Participants and Methods: Participants included a control group (C) of 61 patients with no apparent cerebral vascular lesions and 110 patients with acute-phase cerebral infarction, consisting of a small-vessel occlusion group (S) of 34 patients, a large-artery atherosclerosis group (L) of 41 patients, a cardioembolism group (CE) of 20 patients, and a stroke of undetermined etiology group (U) of 15 patients. Platelet-derived microparticle levels were measured using enzyme-linked immunosorbent assay (ELISA) at the time of admission, and the patients were reclassified into group CP (control level PDMPs), consisting of 70 patients with control PDMP levels, and group HP (high PDMPs), consisting of 40 patients with elevated PDMP levels. All patients underwent cranial magnetic resonance (MR) and carotid ultrasound examinations. Results: Platelet-derived microparticle levels were significantly higher in groups S and L than in group C (P < .01). Concomitant intima-media thickness (IMT; odds ratio [OR] = 1.29, P < .05) and concomitant intracranial stenosis (OR = 3.95, P < .01) were significantly correlated with elevated PDMP levels. Fibrinogen and high-sensitivity CRP levels were significantly higher in group HP than in group CP. Conclusion: Alterations in PDMP levels correlated with the presence of atherothrombotic lesions, and PDMP levels are expected to be useful as a clinical indicator, reflecting the presence of intracranial atherosclerotic lesions in the acute phase of cerebral infarction.

scholarly journals Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

2015 ◽  
Vol 73 (8) ◽  
pp. 648-654 ◽  
Author(s):  
Marcos C. Lange ◽  
Norberto L. Cabral ◽  
Carla H. C. Moro ◽  
Alexandre L. Longo ◽  
Anderson R. Gonçalves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Population Based ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Population Based Study ◽  
Incidence And Mortality ◽  
One Year ◽  
Undetermined Etiology ◽  
And Control ◽  
Adjusted Incidence

Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

Automated Large Artery Occlusion Detection in Stroke: A Single-Center Validation Study of an Artificial Intelligence Algorithm

2021 ◽  
pp. 1-6
Author(s):  
Gabriel Rodrigues ◽  
Clara M. Barreira ◽  
Mehdi Bouslama ◽  
Diogo C. Haussen ◽  
Alhamza Al-Bayati ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Secondary Analysis ◽  
Large Artery ◽  
Single Center ◽  
Characteristic Analysis ◽  
Cohen’S Kappa ◽  
Accurate Identification ◽  
Vessel Occlusion ◽  
Test Characteristic ◽  
Cohen's Kappa

<b><i>Introduction:</i></b> Expediting notification of lesions in acute ischemic stroke (AIS) is critical. Limited availability of experts to assess such lesions and delays in large vessel occlusion (LVO) recognition can negatively affect outcomes. Artificial intelligence (AI) may aid LVO recognition and treatment. This study aims to evaluate the performance of an AI-based algorithm for LVO detection in AIS. <b><i>Methods:</i></b> Retrospective analysis of a database of AIS patients admitted in a single center between 2014 and 2019. Vascular neurologists graded computed tomography angiographies (CTAs) for presence and site of LVO. Studies were analyzed by the Viz-LVO Algorithm® version 1.4 – neural network programmed to detect occlusions from the internal carotid artery terminus (ICA-T) to the Sylvian fissure. Comparisons between human versus AI-based readings were done by test characteristic analysis and Cohen’s kappa. Primary analysis included ICA-T and/or middle cerebral artery (MCA)-M1 LVOs versus non-LVOs/more distal occlusions. Secondary analysis included MCA-M2 occlusions. <b><i>Results:</i></b> 610 CTAs were analyzed. The AI algorithm rejected 2.5% of the CTAs due to poor quality, which were excluded from the analysis. Viz-LVO identified ICA-T and MCA-M1 LVOs with a sensitivity of 87.6%, specificity of 88.5%, and accuracy of 87.9% (AUC 0.88, 95% CI: 0.85–0.92, <i>p</i> &#x3c; 0.001). Cohen’s kappa was 0.74. In the secondary analysis, the algorithm yielded a sensitivity of 80.3%, specificity of 88.5%, and accuracy of 82.7%. The mean run time of the algorithm was 2.78 ± 0.5 min. <b><i>Conclusion:</i></b> Automated AI reading allows for fast and accurate identification of LVO strokes with timely notification to emergency teams, enabling quick decision-making for reperfusion therapies or transfer to specialized centers if needed.

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 Clinical prediction of thrombectomy eligibility: A systematic review and 4-item decision tree

2018 ◽  
Vol 14 (5) ◽  
pp. 530-539 ◽  
Author(s):  
Gaia T Koster ◽  
T Truc My Nguyen ◽  
Erik W van Zwet ◽  
Bjarty L Garcia ◽  
Hannah R Rowling ◽  
...  
Keyword(s):  
Decision Tree ◽  
Prediction Model ◽  
External Validation ◽  
Facial Asymmetry ◽  
Decision Support Tool ◽  
Patient Characteristics ◽  
Group Lasso ◽  
Lasso Regression ◽  
Vessel Occlusion ◽  
Support Tool

Background A clinical large anterior vessel occlusion (LAVO)-prediction scale could reduce treatment delays by allocating intra-arterial thrombectomy (IAT)-eligible patients directly to a comprehensive stroke center. Aim To subtract, validate and compare existing LAVO-prediction scales, and develop a straightforward decision support tool to assess IAT-eligibility. Methods We performed a systematic literature search to identify LAVO-prediction scales. Performance was compared in a prospective, multicenter validation cohort of the Dutch acute Stroke study (DUST) by calculating area under the receiver operating curves (AUROC). With group lasso regression analysis, we constructed a prediction model, incorporating patient characteristics next to National Institutes of Health Stroke Scale (NIHSS) items. Finally, we developed a decision tree algorithm based on dichotomized NIHSS items. Results We identified seven LAVO-prediction scales. From DUST, 1316 patients (35.8% LAVO-rate) from 14 centers were available for validation. FAST-ED and RACE had the highest AUROC (both >0.81, p < 0.01 for comparison with other scales). Group lasso analysis revealed a LAVO-prediction model containing seven NIHSS items (AUROC 0.84). With the GACE (Gaze, facial Asymmetry, level of Consciousness, Extinction/inattention) decision tree, LAVO is predicted (AUROC 0.76) for 61% of patients with assessment of only two dichotomized NIHSS items, and for all patients with four items. Conclusion External validation of seven LAVO-prediction scales showed AUROCs between 0.75 and 0.83. Most scales, however, appear too complex for Emergency Medical Services use with prehospital validation generally lacking. GACE is the first LAVO-prediction scale using a simple decision tree as such increasing feasibility, while maintaining high accuracy. Prehospital prospective validation is planned.

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