Thrombolysis in Stroke Mimics

Winkler, David T.; Fluri, Felix; Fuhr, Peter; Wetzel, Stephan G.; Lyrer, Philippe; Rüegg, Stephan; Engelter, Stefan T.

doi:10.1161/strokeaha.108.530352

Cited by 168 publications

(89 citation statements)

References 8 publications

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“…Several studies have reported on the predictors of stroke mimics (Table 4). 10, 14, 15, 16, 17 Most reported that stroke mimics were characterized by low vascular risk factors in young individuals and low NIHSS scores.…”

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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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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“…Patients with aphasia show often low baseline NIHSS scores and the proportion of patients with stroke mimics is higher [12].…”

Section: Discussionmentioning

confidence: 99%

Prognosis of aphasia in stroke patients early after iv thrombolysis

Kremer

Perren

Kappelin

et al. 2013

Clinical Neurology and Neurosurgery

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Prognosis of aphasia in stroke patients early after iv thrombolysis.Kremer, Christine; Perren, Fabienne; Kappelin, Johan; Selariu, Eufrozina; Abul-Kasim, Kasim Link to publication Citation for published version (APA): Kremer, C., Perren, F., Kappelin, J., Selariu, E., & Abul-Kasim, K. (2013). Prognosis of aphasia in stroke patients early after iv thrombolysis. Clinical Neurology and Neurosurgery, 115(3), 289-292. DOI: 10.1016289-292. DOI: 10. /j.clineuro.2012 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Prognosis of Aphasia in Stroke Patients early after iv Thrombolysis ABSTRACTObjective -Intravenous rt-PA (iv) thrombolysis is given more deliberately to stroke patients presenting with aphasia. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia. Methods -Data of stroke patients treated by iv thrombolysis 2002-2008 was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24 hours. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization Results -50 patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62 %) remained unchanged. Of 28 patients with EICs, 10 (36 %) improved compared to 7 out of 22 (32%) patients without (p=0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24 hours (Kruskal Wallis, p=0.033, p=<0,001, respectively). Conclusion -EICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. 32% improved in their aphasia within 24 hours, probably due to early reperfusion, while 62% remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage.

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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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Thrombolysis in Stroke Mimics

Cited by 168 publications

References 8 publications

Clinical features of stroke mimics in the emergency department

Clinical features of stroke mimics in the emergency department

Prognosis of aphasia in stroke patients early after iv thrombolysis

A HaNDL CASE with PAPILLEDEMA MIMICING TRANSIENT ISCHEMIC ATTACK

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