Safety of Thrombolysis in Stroke Mimics

Zinkstok, Sanne M.; Engelter, Stefan T.; Gensicke, Henrik; Lyrer, Philippe; Ringleb, Peter; Artto, Ville; Putaala, Jukka; Haapaniemi, Elena; Tatlısumak, Turgut; Chen, Yaohua; Leys, Didier; Sarıkaya, Hakan; Michel, Patrik; Odier, Céline; Berrouschot, Jörg; Arnold, Marcel; Heldner, Mirjam Rachel; Zini, Andrea; Fioravanti, Valentina; Padjen, Višnja; Beslac-Bumbasirevic, Ljiljana; Pezzini, Alessandro; Roos, Yvo B.W.E.M.; Nederkoorn, Paul J.

doi:10.1161/strokeaha.111.000126

Cited by 187 publications

(101 citation statements)

References 29 publications

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“…[16][17][18][19] Local study investigators completed the forms using prospectively ascertained in-hospital IVT registries. Completed forms from all centers were compiled in the coordinating center in Amsterdam, where data were pooled and analyzed as described previously.…”

Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Spaander

Zinkstok

Baharoglu

et al. 2017

Stroke

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In patients with acute stroke, previous research has also shown sex to affect outcome after intravenous thrombolysis (IVT) treatment; although outcome was similar between men and women treated with placebo, outcome was better in women after IVT. 4 The biological explanation for this difference remains unclear.A possible explanation could be the difference in recanalization. Women have more cardioembolic strokes, with uniform fibrin-rich clots and therefore a higher affinity of alteplase, resulting in more frequent, faster, and complete recanalization. [5][6][7] Another suggested mechanism could be a difference in endogenous fibrinolysis because of differences in sex hormones between men and women. Estrogen has an indirect influence on the controlling of the fibrinolytic system, as well as a direct neuroprotective activity. [8][9][10][11] However, there are no convincing data to support these hypotheses.Background and Purpose-Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care. Methods-Data were obtained from IVT registries of 12 European tertiary hospitals. The primary outcome was poor functional outcome, defined as a modified Rankin scale score of 3 to 6 at 3 months. We stratified outcome by age in decades. Safety measures were symptomatic intracranial hemorrhage and mortality at 3 months. Results-In this cohort, 9495 patients were treated with IVT, and 4170 (43.9%) were women with a mean age of 71.9 years.After adjustments for baseline differences, female sex remained associated with poor functional outcome (odds ratio, 1.15; 95% confidence interval, 1.02-1.31). There was no association between sex and functional outcome when data were stratified by age. Symptomatic intracranial hemorrhage rate was similar in both sexes (adjusted odds ratio, 0.93; 95% confidence interval, 0.73-1.19), whereas mortality was lower among women (adjusted odds ratio, 0.83; 95% confidence interval, 0.70-0.99). Conclusions-In this large cohort of IVT-treated patients, women more often had poor functional outcome compared with men. This difference was not dependent on age. (Stroke. 2017;48:699-703.

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Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Spaander

Zinkstok

Baharoglu

et al. 2017

Stroke

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“…However, we found no sex differences between SMs and confirmed strokes, and our patients with SMs did not have decreased stroke severity compared to those with confirmed strokes; this differs from prior work. 4,5 Regarding SM predictors, other studies have found lower rates of atrial fibrillation and hypertension in SMs compared with confirmed strokes. Without a detailed medical history, we cannot fully compare how our patients with SMs differed medically from patients with confirmed strokes.…”

Section: Discussionmentioning

confidence: 97%

“…A proportion of patients who present with stroke symptoms and are treated with IV tPA are later found to have a diagnosis other than AIS upon further workup. 4 These patients are considered to have stroke mimics (SMs). Although SM treatment is considered safe with low rates of intracerebral hemorrhage, the complication rate is not zero.…”

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confidence: 99%

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

et al. 2016

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Background: Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke. Methods: This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015. Baseline characteristics, patient language, and final diagnosis were compared between encounters in which the treating neurologist and patient spoke the same language (concordant cases) and encounters in which they did not (discordant cases). Results: A total of 350 patients received IV tPA during the study period. English was the primary language for 52.6%, Spanish for 44.9%, and other languages for 2.6%; 60.3% of cases were classified as language concordant and 39.7% as discordant. We found no significant difference in the proportion of stroke mimics in the language concordant compared to discordant groups (16.6% vs 9.4%, p 5 0.06). Similarly, the proportion of stroke mimics did not differ between English-and Spanish-speaking patients (15.8% vs 11.5%, p 5 0.27). Conclusions: Language discordance was not associated with acute stroke misdiagnosis among patients treated with IV tPA. Prospective evaluation of communication during acute stroke encounters is needed to gain clarity on the role of language discordance in acute stroke misdiagnosis. Neurol Clin Pract 2016;6:389-396 L anguage discordance occurs when a patient and treating physician do not have proficiency in the same language and has been associated with decreased quality of acute care.1-3 However, little is known about the role of language discordance in the emergency department (ED) diagnosis of acute ischemic stroke (AIS).

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“…Zinkstok et al 11. reported that epileptic seizures (41%) and psychiatric disorders (28%) are the most common diseases that can cause stroke mimics, and the frequency of hypoglycemia is low (1%).…”

Section: Discussionmentioning

confidence: 99%

Clinical features of stroke mimics in the emergency department

Okano

Ishimatsu

Kato

et al. 2018

Acute Medicine & Surgery

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AimTo clarify the features of stroke mimics.MethodsWe retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue‐type plasminogen activator treatment time window.ResultsOf 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20.4%), neuropathy‐like symptoms (21 cases, 15.3%), and hypoglycemia (15 cases, 10.9%). Outcomes were survival to hospital discharge for 91.2% and death for 8.8% of the cases. Clinical results were significantly different between stroke mimics and the stroke group for low systolic blood pressure, low National Institutes of Health Stroke Scale score on initial treatment, history of diabetes, and no history of arrhythmia. On multivariate analysis, distinguishing factors for stroke mimics include systolic blood pressure ≤ 140 mmHg, National Institutes of Health Stroke Scale score ≤ 5 points, history of diabetes, and no history of arrhythmia.ConclusionsFrequency of stroke mimics in cases of acute stroke suspected cases is 8.8%, and the most common cause is epilepsy. In order to distinguish stroke mimics, it is useful to understand common diseases presenting as stroke mimics and evaluate clinical features different from stroke by medical interview or nerve examination.

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Safety of Thrombolysis in Stroke Mimics

Cited by 187 publications

References 29 publications

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics

Clinical features of stroke mimics in the emergency department

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