Background and purpose
Patients with stroke mimics (SM), i.e. conditions with stroke‐like symptoms, may risk harm if treated with intravenous thrombolysis (IVT). Current guidelines state low risk of intracerebral hemorrhage based on studies comprising a total of <400 SM cases. We aimed to compare safety and outcomes following IVT between patients with acute ischaemic stroke and mimicking conditions.
Methods
We included IVT‐treated ischaemic stroke patients in the SITS International Stroke Thrombolysis Register 2003–2017, examined with magnetic resonance imaging 22–36 h after treatment. Outcomes were parenchymal hematoma (PH) after treatment, symptomatic intracerebral hemorrhage (SICH) per Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS‐MOST), Second European Co‐operative Stroke Study (ECASS II) and National Institutes of Neurological Disorders and Stroke Study (NINDS) criteria, death and modified Rankin Scale score (mRS) at 3 months.
Results
Of 10 436 patients, 429 mimics (4.1%) were identified. The most common types were functional (30.8%), migraine (17.5%) and seizure (14.2%). Patients with mimics had fewer cerebrovascular risk factors and lower median National Institutes of Health Stroke Scale score [7 (interquartile range, 5–10) vs. 8 (5–14), P < 0.001]. Among mimics versus stroke patients, PH was seen in 1.2% vs. 5.1% (P < 0.001), SICH NINDS in 0.5% vs. 3.9% (P < 0.001), SICH ECASS II in 0.2% vs. 2.1% (P = 0.007) and SICH SITS‐MOST in 0% vs. 0.5% (P = 0.28). Modified Rankin Scale score 0–1 at 3 months was present in 84.1% vs. 57.7% (P < 0.001) and death within 3 months in 2.6% vs. 5.4% (P = 0.028) of mimics and stroke patients, respectively.
Conclusions
This large observational study indicated that PH and SICH following IVT in patients with SM are uncommon.
The present study is part of a survey of subarachnoid hemorrhage cases observed in 16 neurosurgical and 8 neurological departments in Italy between June 1985 and June 1986. Warning signs preceding major hemorrhage were analyzed in 364 patients with intracranial aneurysms confirmed by angiography and reliable clinical history. Seventy-four (20.3%) had warning signs. Clinical features of premonitory warning signs were compared with symptoms of 78 patients without a history of minor leak and clinical grade 1 (according to the criteria of Hunt & Hess) at admission. Symptoms of warning signs are generally clear enough to be considered a misdiagnosis of intracranial aneurysm. Thunderclap headache described as severe, unusual and sudden was the main symptom in every case though the higher frequency of focal of diffuse signs in groups with a correct diagnosis attracted more careful attention in referral and diagnostic-therapeutic management. Improving the identification of minor leak and defining diagnostic strategy are discussed.
Forty-nine cases of dissection of the internal carotid and vertebral arteries are reported in our prospective multicenter study of 35 men and 14 women, with a mean age of 46.77 years. (range 17-60 years). We evaluated etiology, clinical manifestations, investigative techniques, and treatment. Thirty-one patients had so-called spontaneous dissections, although in the remaining 18 minimal or obvious trauma was considered as the etiological factor. Headache and neck pain occurred in 32 patients (65.3%). Local neurological manifestations were present in 15 patients (30.6%) and ischemic cerebral symptoms were present in 41 patients (83.6%). The most-relevant of the diagnostic tools are duplex sonography, magnetic resonance angiography, and angiography. Anticoagulation with heparin followed by warfarin was the treatment of choice in most of our patients. Complete recovery is reported in 14 patients (28.5%); 41 patients showed cerebral ischemic symptoms, of which 13 (26.5%) had good functional recovery. In 28 (57.1%), the NIHSS score decreased from 6.68 to 3.31 during hospitalization.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.