Stroke Mimics under the Drip-and-Ship Paradigm

Mehta, Sonal; Vora, Nirav; Edgell, Randall C.; Allam, Hesham; Alawi, Aws; Koehne, Jennifer; Kumar, Abhay; Feen, Eliahu S.; Cruz‐Flores, Salvador; Alshekhlee, Amer

doi:10.1016/j.jstrokecerebrovasdis.2013.07.012

Cited by 28 publications

(23 citation statements)

References 26 publications

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“…18,22 Finally, other complications of IVT, including asymptomatic intracranial hemorrhages, were not recorded in the majority of case-series studies and the prevalence of these complications among patients with SMs cannot be determined in the present meta-analysis.…”

Section: Strokementioning

confidence: 77%

“…[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%

“…Apart from our tertiary care center study, patient data were prospectively collected only in the study by Förster et al 16 Moreover, selection bias cannot be ruled out in the present meta-analysis as the consecutiveness of the study participants was clearly stated in 5 of 9 included studies, including the present study protocol. [16][17][18]21 Excluding patients after initial recruitment was mentioned in 4 studies. 15,16,19,22 Reporting bias is also probable, as blinding in outcome assessment was not reported in any of the previous study protocols.…”

Section: Strokementioning

confidence: 99%

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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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Section: Strokementioning

confidence: 77%

Section: Strokementioning

confidence: 99%

Section: Meta-analysis Of Case Seriesmentioning

confidence: 99%

Section: Strokementioning

confidence: 99%

See 2 more Smart Citations

Safety of Intravenous Thrombolysis in Stroke Mimics

Tsivgoulis

Zand

Katsanos

et al. 2015

Stroke

141

View full text Add to dashboard Cite

show abstract

“…(Bhalla et al 2000) Table 3. Potential "stroke mimics" and differential diagnoses of acute ischaemic stroke (Artto et al 2012, Mehta et al 2014 In patients with moderate or severe anterior circulation stroke symptoms the diagnosis is often straight-forward. However, there are several caveats to stroke distinguish from mimicking conditions (Table 3).…”

Section: Thalamicmentioning

confidence: 99%