How to identify stroke mimics in patients eligible for intravenous thrombolysis?

Förster, Alex; Griebe, Martin; Wolf, Marc E.; Szabo, Kristina; Hennerici, Michael G.; Kern, Rolf

doi:10.1007/s00415-011-6354-9

Cited by 82 publications

(74 citation statements)

References 21 publications

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“…The incidence of OLAE in our study was slightly higher than that reported in most previous studies, 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] except that of Hurford et al, 29 probably because of the systematic evaluation by nurses during the first 90 minutes, allowing the detection of mild cases that would have remained undetected otherwise.…”

Section: Downloaded Fromcontrasting

confidence: 66%

“…After reading of these 53 articles, 18 were selected for the combined analysis. 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Seventeen articles were published in English 11,[13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29] and 1 in German. 18 The flow chart of the selection of articles is presented in Figure. None of these 18 articles 11,13-29 reported information on the prestroke mRS, alcohol consumption, weight, NIHSS at 2 and 24 hours and at 7 days, presence of infarct on imaging at 22 to 36 hours, s-ICH, infection, malignant infarct, and outcome at 3 months.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Thirteen studies 11,14,[17][18][19][21][22][23][24][25][26][27][28] did not compare any baseline characteristics between patients with and without OLAE and could not be included in a combined analysis of potential predisposing factors. Three studies could be used only for a combined analysis on ACE-I.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Myslimi

Caparros

Dequatre‐Ponchelle

et al. 2016

Stroke

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We used data prospectively collected in a registry of consecutive patients treated with intravenous r-tPA for cerebral ischemia in the stroke center of the Lille University Hospital, from September 30, 2003 to February 4, 2015. The general organization, 4,5 eligibility criteria for thrombolysis, 2,6,7 clinical assessment, 8-10 imaging procedures, and treatment administration 7 have been previously described. 4,5 Patients from this cohort were included in previous studies of our group including one in which the occurrence of OLAE was reported 11 and in a case report. 12Background and Purpose-Orolingual angioedema (OLAE) is a life-threatening complication of intravenous thrombolysis. Our objective was to compare outcomes of patients with and without OLAE. Methods-We prospectively included consecutive patients who received intravenous thrombolysis for cerebral ischemia at Lille University Hospital. We examined tongue and lips every 15 minutes during thrombolysis and ≤30 minutes after. We evaluated the 3-month outcome with the modified Rankin scale (mRS) and compared outcomes of patients with and without OLAE. Results-Of 923 consecutive patients, 20 (2.2%) developed OLAE. None of them needed oro-tracheal intubation. They were more likely to be under angiotensin-converting enzyme inhibitors (adjusted odds ratio [adjOR], 3.9; 95% confidence interval [CI], 1.6-9.7; P=0.005) to have total insular infarcts (OR, 5.0; 95% CI, 1.5-16.5; P=0.004) and tended to develop more symptomatic intracerebral hemorrhages. Results concerning angiotensin-converting enzyme inhibitors were not modified after adjustment for propensity scores (OR, 4.4; 95% CI, 1.6-11.9; P=0.004) or matched analysis based on propensity scores (OR, 3.4; 95% CI, P=0.010). Patients with OLAE did not significantly differ at 3 months for the proportion of patients with mRS score of 0 to 1 (adjOR, 0.9; 95% CI, 0.3-2.1), mRS score of 0 to 2 (adjOR, 0.8; 95% CI, 0.1-1.8), and death (adjOR, 1.1; 95% CI, 0.3-3.8). Conclusions-OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors. Their long-term outcome does not differ from that of other patients.

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confidence: 66%

Section: Review Of the Literaturementioning

confidence: 99%

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Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Myslimi

Caparros

Dequatre‐Ponchelle

et al. 2016

Stroke

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“…Un estudio prospectivo realizado en Alemania del 2004 al 2010 tenía a 42 de 648 (6.5%) de los pacientes con sospecha de ictus isquémico y trombolizados con un diagnóstico final de PI. Solamente reportó 1 caso de reacciones adversas (edema orolingual) 28 . , se realiza un registro de los pacientes tratados con rt-PA iv en la unidad de ictus; de los 621 pacientes tratados solo 15 (2,2%) eran PI.…”

Section: Discussionunclassified

Imitadores del ictus: un reto para el médico de urgencias

Valle

Lopera

Guillán

et al. 2014

Anales Sis San Navarra

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resuMenFundamento. Estudiar el número de pacientes diagnosticados de ictus en el servicio de urgencias hospitalario de un hospital de primer nivel y la proporción de estos pacientes que finalmente eran pseudoictus, así como describir y analizar las variables que pueden ayudar en el diagnóstico diferencial en los servicios de urgencias hospitalarios.Método. Estudio prospectivo de 9 meses. Se incluyeron todos los pacientes valorados en el servicio de Urgencias e ingresados con el diagnóstico de ictus. Se analizaron diversas variables clínicas que incluían la historia previa, la historia del evento actual, el examen físico general y neurológico y la clasificación del NIHSS y de la Oxforshire Community Stroke. El diagnóstico final se realizó por un panel de expertos con acceso a las características clínicas, estudios de imagen y otras pruebas. El análisis univariante y multivariado determinó las características que ayudan a distinguir los ictus de los pseudoictus.resultados. Se registraron 144 casos de ictus; la muestra final la conformó 140 pacientes. El diagnóstico final fue de ictus en 103 de 140 (73,6%) y de pseudoictus en el resto. Once variables predecían el diagnóstico en pacientes que se presentaban con sospecha de ictus: la edad superior a 70 años (p=0,012), una clasificación del NIHSS > 5, lograr una clasificación clínica (p=0,019) capaz de determinar el comienzo exacto (p=0,000), hallazgos vasculares anormales (p=0,014), desviación de la mirada (p=0.042), pérdida de la visión (p=0,052) y reflejo plantar extensor (p=0,025) favorecían el diagnóstico de ictus, mientras que las crisis comiciales (p=0,029), los síntomas neurológicos no congruentes con el territorio vascular (p=0,022) y los hallazgos anormales en otros sistemas (p=0,14) favorecían el diagnostico de pseudoictus.conclusión. Los pseudoictus constituyeron un tercio de los pacientes ingresados desde el servicio de Urgencias como ictus siendo la etiología muy variada. Lograr una historia clínica adecuada y un examen físico preciso es de gran importancia y puede ayudar a facultativos menos experimentados.Palabras claves. Pseudoictus. Ictus. Diagnóstico. abstract background. To study the number of patients diagnosed with a stroke in the emergency service of a first level hospital and the proportion of these patients who were finally stroke mimics, as well as to describe and analyze the variables that can help in differential diagnosis in hospital emergency services.

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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%

Safety of Intravenous Thrombolysis in Stroke Mimics

Tsivgoulis

Zand

Katsanos

et al. 2015

Stroke

141

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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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How to identify stroke mimics in patients eligible for intravenous thrombolysis?

Cited by 82 publications

References 21 publications

Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Imitadores del ictus: un reto para el médico de urgencias

Safety of Intravenous Thrombolysis in Stroke Mimics

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