Ischemic stroke mimics: A comprehensive review

Pohl, Marietta; Hesszenberger, Dávid; Kapus, Krisztián; Mészáros, János; Fehér, Andrea; Váradi, Imre; Pusch, Gabriella; Fejes, Éva; Tibold, Antal; Fehér, Gergely

doi:10.1016/j.jocn.2021.09.025

Cited by 68 publications

(61 citation statements)

References 107 publications

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“…35 Furthermore, given the fact that the use of anticoagulation has been associated with haemorrhage growth, anticoagulation reversal represents a key treatment option for ICH patients on anticoagulation therapy. 36 Many of these strategies depend on a quick differentiation of stroke patients from those with so-called stroke mimicking diseases 37 or different subtypes of stroke, which strongly depends on the training and expertise of the individual teams involved as well as brain imaging availability. To optimise access to treatments and the acute management of stroke patients, strategies crossing institutional boundaries are needed and have to also involve the prehospital stage.…”

Section: Introductionmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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The safety and efficacy of mobile stroke units (MSUs) in prehospital stroke management has recently been investigated in different clinical studies. MSUs are ambulances equipped with a CT scanner, point-of-care lab, telemedicine and are staffed with a stroke specialised medical team. This European Stroke Organisation (ESO) guideline provides an up-to-date evidence-based recommendation to assist decision-makers in their choice on using MSUs for prehospital management of suspected stroke, which includes patients with acute ischaemic stroke (AIS), intracranial haemorrhage (ICH) and stroke mimics. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and aggregated data meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements are provided where sufficient evidence was not available to provide recommendations based on the GRADE approach. We found moderate evidence for suggesting MSU management for patients with suspected stroke. The patient group diagnosed with AIS shows an improvement of functional outcomes at 90 days, reduced onset to treatment times and increased proportion receiving IVT within 60 min from onset. MSU management might be beneficial for patients with ICH as MSU management was associated with a higher proportion of ICH patients being primarily transported to tertiary care stroke centres. No safety concerns (all-cause mortality, proportion of stroke mimics treated with IVT, symptomatic intracranial bleeding and major extracranial bleeding) could be identified for all patients managed with a MSU compared to conventional care. We suggest MSU management to improve prehospital management of suspected stroke patients.

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Section: Introductionmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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“…Approximately one-third of patients initially diagnosed with a stroke are ultimately diagnosed with an SM. The most common types of SMs include: functional disorders, seizures, toxic-metabolic disturbances, brain tumours and migraine 7. We described a patient with C1-INH-HAE attack presented as lacunar syndrome, there was only one previous case report with a C1-INH-HAE type I patient presented as stroke-like episodes 6…”

Section: Discussionmentioning

confidence: 94%

“…Finally, our patient was therefore diagnosed with acute C1-INH-HAE attack presented as an SM. Table 1 shows most common causes of an SM 7…”

Section: Differential Diagnosismentioning

confidence: 99%

Hereditary angio-oedema with C1 inhibitor deficiency type I, an unusual stroke mimic

2022

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Hereditary angio-oedema with C1 inhibitor deficiency (C1-INH-HAE) type I is a rare immune disorder characterised by a deficit of functional C1 esterase inhibitor (C1-INH). Recurrent C1-INH-HAE attacks typically present as generalised skin swelling and abdominal pain. Neurological involvement is very unusual, with a few reports of cephalea and recurrent dizziness. We describe a woman in her 30s diagnosed with C1-INH-HAE type I who was referred to the emergency department suffering from left hemisensory syndrome, with the initial suspicion of an ischaemic stroke. A few hours after hospital admission, she presented an acute attack of facial swelling and abdominal pain, receiving intravenous C1-INH concentrate with complete resolution of all symptoms, including neurological ones. A complete aetiological study ruled out a stroke. We pointed out that C1-INH-HAE attack can be an unusual stroke mimic that responds favourably to replacement therapy.

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“…A major difference between the neuroimaging guidance treatment meta‐analysis and the chosen meta‐analysis are de‐facto exclusions of stroke mimics in the former. Given the marked difference in mortality and likelihood that stroke mimics contribute to survival at 90 days, stroke mimics may be an important source of attrition bias in time‐based treatment meta‐analyses 32 . Meta‐analyses of time‐based treatment are constructed such that both full RCTs and subgroups of RCTs based on treatment time windows are pooled.…”

Section: Discussionmentioning

confidence: 99%

“…Given the marked difference in mortality and likelihood that stroke mimics contribute to survival at 90 days, stroke mimics may be an important source of attrition bias in time-based treatment meta-analyses. 32 Meta-analyses of time-based treatment are constructed such that both full RCTs and subgroups of RCTs based on treatment time windows are pooled.…”

Section: Different Methods Of Imputation Incur Different Tradeoffs In...mentioning

confidence: 99%

Methodological survey of missing outcome data in an alteplase for ischemic stroke meta‐analysis

Garg

2022

Acta Neuro Scandinavica

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Objective Recent national guidelines recommend alteplase treatment for ischemic stroke within 4.5 h of symptom‐onset based on meta‐analyses of randomized controlled clinical trials (RCT). A detailed description of missing outcome data (MOD) due to participant loss to follow‐up has never been published. The objective of this study was to perform a methodlogical survey on missing outcome data in an alteplase for ischemic stroke meta‐analysis. Materials and Methods A methodological survey was performed on a chosen meta‐analysis of alteplase for ischemic stroke RCTs that most closely aligns with recent national guideline recommendations. Data were collected to assess the number of participants lost to follow‐up; differential lost to follow‐up between allocation groups; baseline characteristics of those lost to follow‐up; and the imputation methods used by individual trials and the chosen meta‐analysis. The number of participants lost to follow‐up was compared with the fragility index; and repeated for individually positive RCTs in the meta‐analysis. Results The methodological survey revealed a substantial degree of missing information regarding MOD in the chosen meta‐analysis and in individual RCTs. Single imputation was exclusively used in all RCTs and in the meta‐analysis. The number of participants lost to follow‐up was greater than the fragility index in the chosen meta‐analysis and individually positive component RCTs suggesting that MOD may impact the direction of the reported effect or effect size. Conclusion This methodological survey of an alteplase for ischemic stroke meta‐analysis revealed MOD may be an important source of unrecognized bias. This survey highlights the need for sensitivity analyses using more robust methods of imputation.

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Ischemic stroke mimics: A comprehensive review

Cited by 68 publications

References 107 publications

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Hereditary angio-oedema with C1 inhibitor deficiency type I, an unusual stroke mimic

Methodological survey of missing outcome data in an alteplase for ischemic stroke meta‐analysis

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