Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code

Abstract

Background and purpose Stroke mimics (SMs) account for a significant number of patients attended as stroke code (SC) with an increasing number over the years. Recent studies show perfusion computed tomography (PCT) alterations in some SMs, especially in seizures. The objective of our study was to evaluate the clinical characteristics and PCT alterations in SMs attended as SC in order to identify potential predictors of PCT alterations in SMs. Methods A retrospective study was performed including all SC activations undergoing a multimodal CT study including non‐enhanced computed tomography (CT), CT angiography and PCT, as part of our SC protocol, over 39 months. Patients with a final diagnosis of SM after complete diagnosis work‐up were therefore selected. Clinical variables, diagnosis, PCT alteration patterns and type of map affected (Tmax or time to peak, cerebral blood flow and cerebral blood volume) were registered. Results Stroke mimics represent up to 16% (284/1761) of SCs with a complete multimodal study according to our series. Amongst SMs, 26% (74/284) showed PCT alterations. PCT abnormalities are more prevalent in seizures and status epilepticus and the main pattern is alteration of the time to peak map, of unilateral hemispheric distribution or of non‐vascular territory. In our series, the independent predictors of alteration in PCT in SMs are aphasia, female sex and older age. Conclusions Perfusion computed tomography alterations can be found amongst almost a third of SMs attended as SC, especially older women presenting with aphasia with a final diagnosis of epileptic seizures and status epilepticus.

Frequency and phenotype of headache in covid-19: a study of 2194 patients

“…The study was done in the Valladolid East Healthcare Area, which includes a tertiary academic hospital (Hospital Clínico Universitario de Valladolid) and 22 primary care centers. The reference population was 261,431 patients in total, with the reference population of the included primary care centers ranging between 1896 and 20,930 patients, including both rural areas and urban centers 12 .…”

“…It is unknown whether headache can be misdiagnosed as a primary headache disorder in COVID-19 patients managed in an outpatient setting. In hospitalized patients, the presence of headache independently predicted a lower risk of mortality 2 , and lower risk of intensive care-unit admission 11 , 12 . However, patients with headache also described a high degree of disability, and need for acute treatment was frequent 7 .…”

CT perfusion: stroke, seizure or both?

“…Reported changes seen on CT perfusion with various stroke mimics can at times appear odd. 9 Typical changes of seizures on CT perfusion scan include ipsilateral increased perfusion, or contralateral increased TTP, or unilateral increased cerebral blood flow and decreased TTP. In one review, 91% of patients presenting with seizure to an emergency department over a 4-year period had an abnormal CT perfusion scan, with 66% having the typical changes described above.…”

“…The evidence is weak, but the risk of harm was perceived to be low, and the current guidance would favour thrombolysis in the absence of underlying structural brain abnormality and metabolic or infectious stroke mimic. Because advanced imaging techniques have a role in recognising stroke mimics, 9 many stroke centres have incorporated them into their standard assessment protocols. This case demonstrates the importance of clinical assessment alongside the use of CT perfusion imaging: if the CT perfusion alone had been considered, this male would not have received intravenous thrombolysis and would have probably been left significantly more disabled following his bilateral thalamic infarcts.…”

Stroke Mimics in the Acute Setting: Role of Multimodal CT Protocol

“…1 Although multimodal CT has been reported to be able to distinguish some SM such as seizures, migraine, space-occupying lesions, infections, toxic-metabolic conditions, and others, 10 there are scarce systematic studies on the diagnostic performance of multimodal CT in the diagnosis of SM, with most studies focusing on the diagnostic performance of CTP in seizures as a subgroup of SM. [11][12][13] In this study, we aimed to evaluate the overall diagnostic performance of multimodal CT for the diagnosis of SM not limited to seizures in the setting of acute stroke care.…”