Safety and outcomes of intravenous thrombolysis in stroke mimics

A 6-year, single-care center study and a pooled analysis of reported series

Georgios Tsivgoulis, Andrei Alexandrov, Jason Chang, Vijay K. Sharma, Steven L. Hoover, Annabelle Y. Lao, Wei Liu, Elefterios Stamboulis, Anne Alexandrov, Marc Malkoff, James L. Frey

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Background And Purpose- Efforts to increase the availability and shorten the time delivery of intravenous thrombolysis in patients with acute ischemic stroke carry the potential for tissue plasminogen activator administration in patients with diseases other than stroke, that is, stroke mimics (SMs). We aimed to determine safety and to describe outcomes of intravenous thrombolysis in SM. Methods- We retrospectively analyzed stroke registry data of consecutive acute ischemic stroke admissions treated with intravenous thrombolysis over a 6-year-period. The admission National Institutes of Health Stroke Scale score, vascular risk factors, ischemic lesions on brain MRI (routinely performed as part of diagnostic work-up), and discharge modified Rankin Scale scores were documented. Initial stroke diagnosis in the emergency department was compared with final discharge diagnosis. SM diagnosis was based on the absence of ischemic lesions on diffusion-weighted imaging sequences in addition to an alternate discharge diagnosis. Symptomatic intracranial hemorrhage was defined as brain imaging evidence of intracranial hemorrhage with clinical worsening by National Institutes of Health Stroke Scale score increase of 4 points. Results- Intravenous thrombolysis was administered in 539 patients with acute ischemic stroke (55% men; mean age, 66±15 years). Misdiagnosis of acute ischemic stroke was documented in 56 cases (10.4%; 95% CI, 7.9% to 13.3%). Conversion disorder (26.8%), complicated migraine (19.6%), and seizures (19.6%) were the 3 most common final diagnoses in SM. SMs were younger (mean age, 56±13 years) and had milder baseline stroke severity (median National Institutes of Health Stroke Scale, 6; interquartile range, 4) compared with patients with confirmed acute ischemic stroke (mean age, 67±14 years; median National Institutes of Health Stroke Scale, 8; interquartile range, 10; P<0.001). There was no case of symptomatic intracranial hemorrhage in SMs (0%; 95% CI, 0% to 5.5%); 96% of SMs were functionally independent at hospital discharge (modified Rankin Scale, 0 to 1). Conclusions- Our single-center data indicate favorable safety and outcomes of intravenous thrombolysis administered to SM.

Original languageEnglish (US)
Pages (from-to)1771-1774
Number of pages4
JournalStroke
Volume42
Issue number6
DOIs
StatePublished - Jun 1 2011

Fingerprint

Stroke
Safety
National Institutes of Health (U.S.)
Intracranial Hemorrhages
Conversion Disorder
Migraine with Aura
Tissue Plasminogen Activator
Diagnostic Errors
Neuroimaging
Registries
Hospital Emergency Service
Seizures

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Safety and outcomes of intravenous thrombolysis in stroke mimics : A 6-year, single-care center study and a pooled analysis of reported series. / Tsivgoulis, Georgios; Alexandrov, Andrei; Chang, Jason; Sharma, Vijay K.; Hoover, Steven L.; Lao, Annabelle Y.; Liu, Wei; Stamboulis, Elefterios; Alexandrov, Anne; Malkoff, Marc; Frey, James L.

In: Stroke, Vol. 42, No. 6, 01.06.2011, p. 1771-1774.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Alexandrov, Andrei ; Chang, Jason ; Sharma, Vijay K. ; Hoover, Steven L. ; Lao, Annabelle Y. ; Liu, Wei ; Stamboulis, Elefterios ; Alexandrov, Anne ; Malkoff, Marc ; Frey, James L. / Safety and outcomes of intravenous thrombolysis in stroke mimics : A 6-year, single-care center study and a pooled analysis of reported series. In: Stroke. 2011 ; Vol. 42, No. 6. pp. 1771-1774.
@article{e2aededacfb0484da56ebb1e6247dfe4,
title = "Safety and outcomes of intravenous thrombolysis in stroke mimics: A 6-year, single-care center study and a pooled analysis of reported series",
abstract = "Background And Purpose- Efforts to increase the availability and shorten the time delivery of intravenous thrombolysis in patients with acute ischemic stroke carry the potential for tissue plasminogen activator administration in patients with diseases other than stroke, that is, stroke mimics (SMs). We aimed to determine safety and to describe outcomes of intravenous thrombolysis in SM. Methods- We retrospectively analyzed stroke registry data of consecutive acute ischemic stroke admissions treated with intravenous thrombolysis over a 6-year-period. The admission National Institutes of Health Stroke Scale score, vascular risk factors, ischemic lesions on brain MRI (routinely performed as part of diagnostic work-up), and discharge modified Rankin Scale scores were documented. Initial stroke diagnosis in the emergency department was compared with final discharge diagnosis. SM diagnosis was based on the absence of ischemic lesions on diffusion-weighted imaging sequences in addition to an alternate discharge diagnosis. Symptomatic intracranial hemorrhage was defined as brain imaging evidence of intracranial hemorrhage with clinical worsening by National Institutes of Health Stroke Scale score increase of 4 points. Results- Intravenous thrombolysis was administered in 539 patients with acute ischemic stroke (55{\%} men; mean age, 66±15 years). Misdiagnosis of acute ischemic stroke was documented in 56 cases (10.4{\%}; 95{\%} CI, 7.9{\%} to 13.3{\%}). Conversion disorder (26.8{\%}), complicated migraine (19.6{\%}), and seizures (19.6{\%}) were the 3 most common final diagnoses in SM. SMs were younger (mean age, 56±13 years) and had milder baseline stroke severity (median National Institutes of Health Stroke Scale, 6; interquartile range, 4) compared with patients with confirmed acute ischemic stroke (mean age, 67±14 years; median National Institutes of Health Stroke Scale, 8; interquartile range, 10; P<0.001). There was no case of symptomatic intracranial hemorrhage in SMs (0{\%}; 95{\%} CI, 0{\%} to 5.5{\%}); 96{\%} of SMs were functionally independent at hospital discharge (modified Rankin Scale, 0 to 1). Conclusions- Our single-center data indicate favorable safety and outcomes of intravenous thrombolysis administered to SM.",
author = "Georgios Tsivgoulis and Andrei Alexandrov and Jason Chang and Sharma, {Vijay K.} and Hoover, {Steven L.} and Lao, {Annabelle Y.} and Wei Liu and Elefterios Stamboulis and Anne Alexandrov and Marc Malkoff and Frey, {James L.}",
year = "2011",
month = "6",
day = "1",
doi = "10.1161/STROKEAHA.110.609339",
language = "English (US)",
volume = "42",
pages = "1771--1774",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Safety and outcomes of intravenous thrombolysis in stroke mimics

T2 - A 6-year, single-care center study and a pooled analysis of reported series

AU - Tsivgoulis, Georgios

AU - Alexandrov, Andrei

AU - Chang, Jason

AU - Sharma, Vijay K.

AU - Hoover, Steven L.

AU - Lao, Annabelle Y.

AU - Liu, Wei

AU - Stamboulis, Elefterios

AU - Alexandrov, Anne

AU - Malkoff, Marc

AU - Frey, James L.

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background And Purpose- Efforts to increase the availability and shorten the time delivery of intravenous thrombolysis in patients with acute ischemic stroke carry the potential for tissue plasminogen activator administration in patients with diseases other than stroke, that is, stroke mimics (SMs). We aimed to determine safety and to describe outcomes of intravenous thrombolysis in SM. Methods- We retrospectively analyzed stroke registry data of consecutive acute ischemic stroke admissions treated with intravenous thrombolysis over a 6-year-period. The admission National Institutes of Health Stroke Scale score, vascular risk factors, ischemic lesions on brain MRI (routinely performed as part of diagnostic work-up), and discharge modified Rankin Scale scores were documented. Initial stroke diagnosis in the emergency department was compared with final discharge diagnosis. SM diagnosis was based on the absence of ischemic lesions on diffusion-weighted imaging sequences in addition to an alternate discharge diagnosis. Symptomatic intracranial hemorrhage was defined as brain imaging evidence of intracranial hemorrhage with clinical worsening by National Institutes of Health Stroke Scale score increase of 4 points. Results- Intravenous thrombolysis was administered in 539 patients with acute ischemic stroke (55% men; mean age, 66±15 years). Misdiagnosis of acute ischemic stroke was documented in 56 cases (10.4%; 95% CI, 7.9% to 13.3%). Conversion disorder (26.8%), complicated migraine (19.6%), and seizures (19.6%) were the 3 most common final diagnoses in SM. SMs were younger (mean age, 56±13 years) and had milder baseline stroke severity (median National Institutes of Health Stroke Scale, 6; interquartile range, 4) compared with patients with confirmed acute ischemic stroke (mean age, 67±14 years; median National Institutes of Health Stroke Scale, 8; interquartile range, 10; P<0.001). There was no case of symptomatic intracranial hemorrhage in SMs (0%; 95% CI, 0% to 5.5%); 96% of SMs were functionally independent at hospital discharge (modified Rankin Scale, 0 to 1). Conclusions- Our single-center data indicate favorable safety and outcomes of intravenous thrombolysis administered to SM.

AB - Background And Purpose- Efforts to increase the availability and shorten the time delivery of intravenous thrombolysis in patients with acute ischemic stroke carry the potential for tissue plasminogen activator administration in patients with diseases other than stroke, that is, stroke mimics (SMs). We aimed to determine safety and to describe outcomes of intravenous thrombolysis in SM. Methods- We retrospectively analyzed stroke registry data of consecutive acute ischemic stroke admissions treated with intravenous thrombolysis over a 6-year-period. The admission National Institutes of Health Stroke Scale score, vascular risk factors, ischemic lesions on brain MRI (routinely performed as part of diagnostic work-up), and discharge modified Rankin Scale scores were documented. Initial stroke diagnosis in the emergency department was compared with final discharge diagnosis. SM diagnosis was based on the absence of ischemic lesions on diffusion-weighted imaging sequences in addition to an alternate discharge diagnosis. Symptomatic intracranial hemorrhage was defined as brain imaging evidence of intracranial hemorrhage with clinical worsening by National Institutes of Health Stroke Scale score increase of 4 points. Results- Intravenous thrombolysis was administered in 539 patients with acute ischemic stroke (55% men; mean age, 66±15 years). Misdiagnosis of acute ischemic stroke was documented in 56 cases (10.4%; 95% CI, 7.9% to 13.3%). Conversion disorder (26.8%), complicated migraine (19.6%), and seizures (19.6%) were the 3 most common final diagnoses in SM. SMs were younger (mean age, 56±13 years) and had milder baseline stroke severity (median National Institutes of Health Stroke Scale, 6; interquartile range, 4) compared with patients with confirmed acute ischemic stroke (mean age, 67±14 years; median National Institutes of Health Stroke Scale, 8; interquartile range, 10; P<0.001). There was no case of symptomatic intracranial hemorrhage in SMs (0%; 95% CI, 0% to 5.5%); 96% of SMs were functionally independent at hospital discharge (modified Rankin Scale, 0 to 1). Conclusions- Our single-center data indicate favorable safety and outcomes of intravenous thrombolysis administered to SM.

UR - http://www.scopus.com/inward/record.url?scp=79958288886&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958288886&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.609339

DO - 10.1161/STROKEAHA.110.609339

M3 - Article

VL - 42

SP - 1771

EP - 1774

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -