Stroke Mimics and Intravenous Thrombolysis

Artto, Ville; Putaala, Jukka; Strbian, Daniel; Meretoja, Atte; Piironen, Katja; Liebkind, Ron; Silvennoinen, Heli; Atula, Sari; Häppölä, Olli

doi:10.1016/j.annemergmed.2011.09.011

Cited by 61 publications

(40 citation statements)

References 13 publications

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“…[5][6][7][8][9] The available data about the outcomes of patients with SMs inadvertently treated with AIS are almost exclusively limited in single-center case-series studies including small numbers of patients (≤100). [10][11][12][13][14][15][16][17][18][19][20][21][22] In view of the former considerations, the aim of this study was to determine the safety of IVT in SMs by presenting prospective, single-center data from a tertiary care stroke center for a 5-year period and by conducting a comprehensive metaanalysis of all available case series.…”

Section: Strokementioning

confidence: 99%

“…After retrieving the full-text version of the aforementioned 13 studies, 5 studies were excluded because they reported data that were already published in previous studies (overlapping data). [11][12][13][14] In the final presentation of the literature search results, there was no conflict or disagreement between the 2 reviewers and the 8 studies that met the study protocol's inclusion criteria [15][16][17][18][19][20][21][22] together with the data from the protocol of this study were included both in the qualitative and quantitative synthesis (Figure 1). The characteristics and bias assessment of the included studies, comprising 8942 total patients with IVT and 392 patients with SMs (4.38%), are shown in Table I in the online-only Data Supplement.…”

Section: Meta-analysis Of Case Seriesmentioning

confidence: 99%

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Safety of Intravenous Thrombolysis in Stroke Mimics

Tsivgoulis

Zand

Katsanos

et al. 2015

Stroke

Self Cite

144

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Background and Purpose— Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. Methods— We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Results— Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3–22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%–2%) and 0.3% (95% confidence interval, 0%–2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14–0.77; P =0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07–3.73; P <0.00001). Conclusions— Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.

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Section: Strokementioning

confidence: 99%

Section: Meta-analysis Of Case Seriesmentioning

confidence: 99%

Safety of Intravenous Thrombolysis in Stroke Mimics

Tsivgoulis

Zand

Katsanos

et al. 2015

Stroke

Self Cite

144

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“…Bu nedenle de iskemik inme ön tanısı olan hastalarda, erken dönemde ayırıcı tanı sağlanamıyor ise, IV-tPA uygulamasının getireceği potansiyel yararın önüne geçmemek için, vakit kaybetmeksizin IV-tPA uygulamasının gerçekleştirilmesi önerilmektedir. [6][7][8] Bu bakış açısı ile olgumuz da, endikasyon dahilinde, başağrısı yakınmasının ön planda olmadığı, pür motor afazi kliniği ile IV-tPA uygulamasına aday olmuş, hızla düzelen kliniği itibariyle planlanan tedavi gerçekleştirilmemiştir.…”

Section: Discussionunclassified

A HaNDL CASE with PAPILLEDEMA MIMICING TRANSIENT ISCHEMIC ATTACK

Gungor

Çakar²,

Orhan³

et al. 2016

Agri

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ÖzetBeyin omurilik sıvısı (BOS) lenfositozu ve geçici nörolojik bulguların eşlik ettiği baş ağrısı sendromu ('The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis: HaNDL') nadir görülen, iyi seyirli, kendini sınırlayan ve az tanınan bir sendromdur. Zengin nörolojik semptomatolojisi ile morbidite ve mortaliteye yol açan çok sayıda hastalığı taklit edebilen bu sendrom için, klinik şüphe ile yapılan BOS incelemesi tanısal değer taşır. Etiyopatogenezi tam olarak bilinmese de, otoimmünite ön planda düşünülmektedir. Bu yazıda, ilk klinik prezentasyonu geçici iskemik atağı taklit eden, geçici ve tekrarlayıcı nörolojik bulgular gösteren epizodları ve normal BOS basıncına eşlik eden papilödem bulgusu ile bir HaNDL olgusu tartışıldı, sendromun tanımı, klinik tablo ve epidemiyolojisi, etiyopatogenezi, ayırıcı tanısı ve tedavisi literatür eşliğinde gözden geçirildi.Anahtar sözcükler: HaNDL, inme taklidi; intravenöz trombolitik tedavi; lenfositik pleositoz; otoimmün hastalık. SummaryThe syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL), is a rare, benign, self-limiting syndrome that is not well known. Cerebrospinal fluid examination (CSF) on clinical suspicion has diagnostic value for this syndrome, which has a rich neurological symptomatology that can mimic many diseases causing mortality and morbidity. Although the ethiopathogenesis of this syndrome is not fully known, autoimmunity is thought to be in the foreground. Described in this article is a HaNDL case that on first clinic presentation appeared to be a transient ischemic attack (TIA) with temporary but recurring neurological findings and normal CSF pressure accompanied by papilledema. Clinical features, epidemiology, ethiopathogenesis, differential diagnosis, and treatment of this syndrome are reviewed according to the literature.

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“…In one of our patients, an erroneous thrombolysis decision was made partially based on the over-interpretation of subtle focal abnormalities on a CTP with movement artefacts; this intervention remained without serious consequences [31,32]. Intravenous thrombolysis may be given occasionally for stroke mimics [31,32]; this is not only due to atypical clinical presentations that may not be recognised, but also to the little time available for emergency room physicians and neurologists before taking treatment decisions [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous thrombolysis may be given occasionally for stroke mimics [31,32]; this is not only due to atypical clinical presentations that may not be recognised, but also to the little time available for emergency room physicians and neurologists before taking treatment decisions [33,34]. Furthermore, the poor sensitivity of NCCT as compared to CTP and, in particular, DWI MRI [35] can partially explain why there is no golden standard for skipping the stroke-mimic trap.…”

Section: Discussionmentioning

confidence: 99%

Aseptic meningoencephalitis mimicking transient ischaemic attacks

et al. 2013

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Purpose To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. Methods This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. Results A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Conclusions Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.

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Stroke Mimics and Intravenous Thrombolysis

Cited by 61 publications

References 13 publications

Safety of Intravenous Thrombolysis in Stroke Mimics

Safety of Intravenous Thrombolysis in Stroke Mimics

A HaNDL CASE with PAPILLEDEMA MIMICING TRANSIENT ISCHEMIC ATTACK

Aseptic meningoencephalitis mimicking transient ischaemic attacks

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