Thrombolysis of stroke mimics via telestroke. Issue 3 (1st February 2022)

• Record Type: Journal Article
• Authors: Lee, Vivien H; Howell, Ravyn; Yadav, Randheer; Heaton, Sharon; Wiles, Karen L; Lakhani, Sushil
• Is Part Of: Stroke and vascular neurology. Volume 7:Issue 3(2022)
• Page Start: 267
• Page End: 270
• Publication Date: 2022-02-01
• Subjects: stroke -- thrombolysis; Cerebrovascular disease -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.81005
• DOI: 10.1136/svn-2020-000776
• Languages: English
• ISSNs: 2059-8688

Abstract

Abstract : Background: The rate of intravenous tissue plasminogen activator (IVtPA) administered to stroke mimics (SM) occurs in 24%–44% of telestroke series. Methods: We reviewed 270 suspected acute ischaemic stroke (AIS) patients who were evaluated by telestroke and received IVtPA from 1 July 2016 to 30 September 2017 at our academic comprehensive stroke centre. Results: Among 270 AIS patients who received IVtPA via telestroke, 64 (23.7%) were diagnosed with SM. Compared with patients who had a stroke, the SM group was younger (mean age 56.4 vs 68.2, p<0.0001), more likely to be female (60.9% vs 45.6%, p=0.0324) and had longer door-to-needle times (85.3 vs 69.9, p=0.0008). The most common SM diagnoses were migraine 26 (40.6%), conversion disorder 12 (18.8%), encephalopathy 7 (10.9%) and unmasking (9.4%). Among the SM, migraine and conversion disorder were younger compared with the other subgroups (p<0.001). Functional exam elements were noted more frequently in conversion disorder (66.7%) and migraine (34.6%), but rare in other diagnoses (p=0.006). Among the SM, 23 (35.9%) had a history of a prior similar episodes, and 15 (23.4%) had a history of more than 5 spells. Conclusions: In our telestroke programme, 23.7% of those administered thrombolysis had a final diagnosis of SM.