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Different pattern of clinical deficits in stroke mimics treated with intravenous thrombolysis


Sarikaya, H; Yilmaz, M B; Luft, A R; Gantenbein, A R (2012). Different pattern of clinical deficits in stroke mimics treated with intravenous thrombolysis. European Neurology, 68(6):344-349.

Abstract

Background: Guidelines recommend intravenous thrombolysis (IVT) to be applied as early as possible in ischemic stroke (IS), while clinical presentation is often assessed by using the National Institutes of Health Stroke Scale (NIHSS). However, diagnostic workup under time pressure bears the risk of misdiagnosis. Little is known about whether NIHSS could help to differentiate between IS and stroke mimics (SM) in patients being evaluated for IVT. Methods: Prospectively collected data of 326 consecutive patients treated with IVT were analyzed. Baseline characteristics and NIHSS subscores were compared between SM and IS. Results: Among 326 patients, 23 (7%) had a final diagnosis other than IS. Age and vascular risk factors were comparable in both groups. Patients with SM less often had oculomotor disturbance (0 vs. 37%, p < 0.001), dysarthria (9 vs. 51%, p < 0.001), hemineglect (0 vs. 30%, p < 0.01), hemianopia (0 vs. 22%, p < 0.01) and facial palsy (33 vs. 70%, p < 0.01). On the other hand, global aphasia without hemiparesis was more prevalent in SM patients (43 vs. 6%, p < 0.001). Conclusion: Our study suggests that patients with SM undergoing IVT present with a different pattern of clinical deficits than patients with IS.

Abstract

Background: Guidelines recommend intravenous thrombolysis (IVT) to be applied as early as possible in ischemic stroke (IS), while clinical presentation is often assessed by using the National Institutes of Health Stroke Scale (NIHSS). However, diagnostic workup under time pressure bears the risk of misdiagnosis. Little is known about whether NIHSS could help to differentiate between IS and stroke mimics (SM) in patients being evaluated for IVT. Methods: Prospectively collected data of 326 consecutive patients treated with IVT were analyzed. Baseline characteristics and NIHSS subscores were compared between SM and IS. Results: Among 326 patients, 23 (7%) had a final diagnosis other than IS. Age and vascular risk factors were comparable in both groups. Patients with SM less often had oculomotor disturbance (0 vs. 37%, p < 0.001), dysarthria (9 vs. 51%, p < 0.001), hemineglect (0 vs. 30%, p < 0.01), hemianopia (0 vs. 22%, p < 0.01) and facial palsy (33 vs. 70%, p < 0.01). On the other hand, global aphasia without hemiparesis was more prevalent in SM patients (43 vs. 6%, p < 0.001). Conclusion: Our study suggests that patients with SM undergoing IVT present with a different pattern of clinical deficits than patients with IS.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:07 Dec 2012 12:23
Last Modified:21 Jun 2016 15:43
Publisher:Karger
Series Name:European neurology
ISSN:0014-3022
Publisher DOI:https://doi.org/10.1159/000337677
PubMed ID:23095714

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