TY - JOUR
T1 - Description of stroke mimics after complete neurovascular assessment
AU - Avellaneda-Gómez, C.
AU - Rodríguez Campello, A.
AU - Giralt Steinhauer, E.
AU - Gómez González, A.
AU - Serra Martínez, M.
AU - de Ceballos Cerrajería, P.
AU - Zabalza de Torres, A.
AU - Cuadrado-Godia, E.
AU - Ois Santiago, A.
AU - Jiménez-Conde, J.
AU - Roquer, J.
N1 - Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - © 2016 Sociedad Española de Neurología Introduction: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. Objective: The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis. Methods: Prospective study including all patients admitted to a tertiary university hospital between June 2005 and April 2015 with a diagnosis of acute stroke. We analysed demographic data, cardiovascular risk factors, time from code stroke activation to admission, stroke severity (NIHSS), final destination after discharge, degree of disability (mRS), and treatment. We compared SM and ischaemic strokes. We ruled out patients with intracranial haemorrhage, subarachnoid haemorrhage, or other causes of SM that may be detected on the baseline CT scan. Results: Four hundred four of the 4,570 included patients (8.8%) were found to have SM. Patients with SM were younger (70.3 vs. 74, P <.0001), less likely to exhibit cardiovascular risk factors and atrial fibrillation (13 vs. 34%, P <.0001), scored lower on the NIHSS at baseline (2 vs. 4, P <.0001), and included fewer cases of aphasia (9.4 vs. 19.6%, P <.02) and dysphagia (1.2 vs. 17%, P <.0001) than patients with stroke. SM caused fewer code stroke activations (28 vs. 40%, P <.0001). Patients with SM required shorter hospital stays (4.9 vs. 7.8 days, P <.0001), were less frequently admitted to the stroke unit (47 vs. 60%, P <.0001) and more frequently discharged home (95 vs. 62%, P <.0001), and had better outcomes (mRS scores 0-2; 76 vs. 54%, P <.0001). Intravenous fibrinolysis was administered to 4.7% of these patients. Epileptic seizures were the most frequent cause of SM (26%). Conclusions: In our sample, 8.8% of all diagnoses of ischaemic stroke were SM. These events have different demographic, clinical, and prognostic characteristics; epilepsy is the most common aetiology. Despite receiving specialised emergency care, 19 patients with SM (4.7%) were treated with intravenous fibrinolysis.
AB - © 2016 Sociedad Española de Neurología Introduction: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. Objective: The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis. Methods: Prospective study including all patients admitted to a tertiary university hospital between June 2005 and April 2015 with a diagnosis of acute stroke. We analysed demographic data, cardiovascular risk factors, time from code stroke activation to admission, stroke severity (NIHSS), final destination after discharge, degree of disability (mRS), and treatment. We compared SM and ischaemic strokes. We ruled out patients with intracranial haemorrhage, subarachnoid haemorrhage, or other causes of SM that may be detected on the baseline CT scan. Results: Four hundred four of the 4,570 included patients (8.8%) were found to have SM. Patients with SM were younger (70.3 vs. 74, P <.0001), less likely to exhibit cardiovascular risk factors and atrial fibrillation (13 vs. 34%, P <.0001), scored lower on the NIHSS at baseline (2 vs. 4, P <.0001), and included fewer cases of aphasia (9.4 vs. 19.6%, P <.02) and dysphagia (1.2 vs. 17%, P <.0001) than patients with stroke. SM caused fewer code stroke activations (28 vs. 40%, P <.0001). Patients with SM required shorter hospital stays (4.9 vs. 7.8 days, P <.0001), were less frequently admitted to the stroke unit (47 vs. 60%, P <.0001) and more frequently discharged home (95 vs. 62%, P <.0001), and had better outcomes (mRS scores 0-2; 76 vs. 54%, P <.0001). Intravenous fibrinolysis was administered to 4.7% of these patients. Epileptic seizures were the most frequent cause of SM (26%). Conclusions: In our sample, 8.8% of all diagnoses of ischaemic stroke were SM. These events have different demographic, clinical, and prognostic characteristics; epilepsy is the most common aetiology. Despite receiving specialised emergency care, 19 patients with SM (4.7%) were treated with intravenous fibrinolysis.
KW - Acute stroke
KW - Epileptic seizures
KW - Fibrinolysis
KW - Ischaemic stroke
KW - Stroke Code
KW - Stroke mimic
KW - Diagnosis, Differential
KW - Prospective Studies
KW - Stroke/diagnosis
KW - Tertiary Care Centers
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Male
KW - Treatment Outcome
KW - Aged, 80 and over
KW - Female
KW - Aged
UR - http://www.mendeley.com/research/description-stroke-mimics-after-complete-neurovascular-assessment
U2 - 10.1016/j.nrl.2016.10.006
DO - 10.1016/j.nrl.2016.10.006
M3 - Article
C2 - 28169020
SN - 0213-4853
VL - 34
SP - 7
EP - 13
JO - Neurologia
JF - Neurologia
ER -