Misdiagnoses in 1,250 Consecutive Patients Admitted to an Acute Stroke Unit

Robinson, Thompson; Waddington, Andrew; Ward-Close, Suzanne; Taub, Nick; Potter, John F.; Cesari, Maurizio; Rossi, Gian Paolo; Dyne, Katharine M.; Fiore, D.; Pessina, Achille C.; Waxman, Stephen G.; Castillo, José María; Dávalos, Antoni; Lema, M; Serena, Joaquı́n; Noya, M; Straten, A. van; Meulen, J.H.P. van der; Crevel, H. van; Habbema, J. Dik F.; Limburg, M.; Porsdal, Vibeke; Boysen, Gudrun; Hupperts, Raymond; Lodder, J.; Raak, L. Heuts-van; Kessels, Fons; Bray, J; Baud, J. M.; Dauzat, M.

doi:10.1159/000108210

Cited by 20 publications

References 7 publications

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Werden Epilepsien bei älteren Menschen übersehen?

Flierl-Hecht

Pfäfflin

May³

et al. 2003

Nervenarzt

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The symptoms of epileptic seizures in old patients differ from those in younger patients. Therefore, these seizures may be misinterpreted as symptoms of other "typical" diseases in old people. In an old people's home, we assessed whether a standardized questionnaire is able to reveal undiagnosed epilepsy in the elderly. Reported sudden falls, loss of consciousness, and cramps were the criteria for further diagnostic procedures. We found epilepsy in 11 of 389 study participants. In four of them (1% of the total sample), the epilepsy was newly diagnosed; five more cases remained unclear. Therefore, the total number of epileptic patients might have been even higher. Most of the reported sudden falls and unconsciousness (89%) were due to internal medical or other neurological or orthopaedic causes. Once these have been excluded, the diagnosis of epilepsy should be considered. The results of our pilot study suggest that epilepsy in old people's homes is often unrecognised. Early diagnosis and treatment of epilepsy in the elderly is important to improve prognosis and social consequences for affected persons.

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Werden Epilepsien bei älteren Menschen übersehen?

Flierl-Hecht

Pfäfflin

May³

et al. 2003

Nervenarzt

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Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia

et al. 2013

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The question of whether i.v. rt-PA is beneficial in patients with ischaemic stroke and atrial fibrillation (AF) remains unresolved. Our objective was to evaluate the outcome of patients with AF who received i.v. rt-PA for stroke in the registries of Lille (France) and Belgrade (Serbia). End-points were poor outcome [modified Rankin Scale (mRS) 3-6], and symptomatic haemorrhagic transformation (sHT) according to ECASS3. Of 734 consecutive patients, 155 (21.2 %) had AF. The unadjusted comparison found patients with AF to be 12 years older, more likely to be women, to have hypertension, and baseline INR > 1.2, and less likely to be smokers. They had higher baseline NIHSS scores, diastolic blood pressure, and serum glucose concentrations, and lower platelet counts. They did not differ for sHT (5.8 vs. 5.5 %; p = 0.893), but they more frequently had poor outcomes (52.3 vs. 35.2 %; p < 0.001) and death (21.9 vs. 9.0 %; p < 0.001). The only independent predictor of sHT was baseline NIHSS (adjOR 1.05 per 1 point increase; 95 % CI 1.01-1.10). Independent variables associated with poor outcome were age (adjOR 1.04 for 1 year increase; 95 % CI 1.03-1.06), baseline NIHSS (adjOR 1.17 per 1 point increase; 95 % CI 1.13-1.21), and sHT (adjOR 47.6; 95 % CI 10.2-250) but not AF. In patients treated with i.v. rt-PA for cerebral ischaemia, those with AF have worse outcomes because they are older and have more severe strokes at admission. This result suggests that we should focus on prevention and research of more aggressive strategies at the acute stage.

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