Intravenous thrombolysis in stroke mimics: results from the SITS International Stroke Thrombolysis Register

Keselman, B, Cooray, C, Vanhooren, G, Bassi, P, Consoli, D, Nichelli, P, Peeters, Anna, Sanak, D, Zini, A, Wahlgren, N, Ahmed, N and Mazya, MV 2019, Intravenous thrombolysis in stroke mimics: results from the SITS International Stroke Thrombolysis Register, European journal of neurology, vol. 26, no. 8, pp. 1091-1097, doi: 10.1111/ene.13944.

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Title Intravenous thrombolysis in stroke mimics: results from the SITS International Stroke Thrombolysis Register
Author(s) Keselman, B
Cooray, C
Vanhooren, G
Bassi, P
Consoli, D
Nichelli, P
Peeters, AnnaORCID iD for Peeters, Anna
Sanak, D
Zini, A
Wahlgren, N
Ahmed, N
Mazya, MV
Journal name European journal of neurology
Volume number 26
Issue number 8
Start page 1091
End page 1097
Total pages 7
Publisher Wiley
Place of publication Chichester, Eng.
Publication date 2019-08
ISSN 1351-5101
Keyword(s) cerebral infarct
diagnostic error
intracerebral hemorrhage
ischaemic stroke
stroke management
Summary Background and purpose: Patients with stroke mimics (SM), i.e. conditions with stroke-like symptoms, may risk harm if treated with intravenous thrombolysis (IVT). Current guidelines state low risk of intracerebral hemorrhage based on studies comprising a total of <400 SM cases. We aimed to compare safety and outcomes following IVT between patients with acute ischaemic stroke and mimicking conditions. Methods: We included IVT-treated ischaemic stroke patients in the SITS International Stroke Thrombolysis Register 2003–2017, examined with magnetic resonance imaging 22–36 h after treatment. Outcomes were parenchymal hematoma (PH) after treatment, symptomatic intracerebral hemorrhage (SICH) per Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST), Second European Co-operative Stroke Study (ECASS II) and National Institutes of Neurological Disorders and Stroke Study (NINDS) criteria, death and modified Rankin Scale score (mRS) at 3 months. Results: Of 10 436 patients, 429 mimics (4.1%) were identified. The most common types were functional (30.8%), migraine (17.5%) and seizure (14.2%). Patients with mimics had fewer cerebrovascular risk factors and lower median National Institutes of Health Stroke Scale score [7 (interquartile range, 5–10) vs. 8 (5–14), P < 0.001]. Among mimics versus stroke patients, PH was seen in 1.2% vs. 5.1% (P < 0.001), SICH NINDS in 0.5% vs. 3.9% (P < 0.001), SICH ECASS II in 0.2% vs. 2.1% (P = 0.007) and SICH SITS-MOST in 0% vs. 0.5% (P = 0.28). Modified Rankin Scale score 0–1 at 3 months was present in 84.1% vs. 57.7% (P < 0.001) and death within 3 months in 2.6% vs. 5.4% (P = 0.028) of mimics and stroke patients, respectively. Conclusions: This large observational study indicated that PH and SICH following IVT in patients with SM are uncommon.
Language eng
DOI 10.1111/ene.13944
Indigenous content off
Field of Research 1103 Clinical Sciences
1109 Neurosciences
HERDC Research category C1 Refereed article in a scholarly journal
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