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

B Keselman1, C Cooray1, G Vanhooren2

  • 1Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

European Journal of Neurology
|February 23, 2019
PubMed
Abstract

Insights

Intravenous thrombolysis (IVT) is safe for stroke mimics (SM), with uncommon parenchymal hematoma and symptomatic intracerebral hemorrhage. Patients with SM treated with IVT showed better functional outcomes and lower mortality rates compared to stroke patients.

Area of Science:

  • Neurology
  • Emergency Medicine
  • Radiology

Background:

  • Stroke mimics (SM) present with stroke-like symptoms, posing a risk if treated with intravenous thrombolysis (IVT).
  • Existing guidelines suggest a low risk of intracerebral hemorrhage in SM, based on limited data (<400 cases).

Purpose of the Study:

  • To compare the safety and outcomes of IVT in patients with acute ischemic stroke versus those with mimicking conditions.

Main Methods:

  • Analysis of IVT-treated patients from the SITS International Stroke Thrombolysis Register (2003-2017).
  • Magnetic resonance imaging (MRI) was performed 22-36 hours post-treatment.
  • Outcomes assessed included parenchymal hematoma (PH), symptomatic intracerebral hemorrhage (SICH) by various criteria, 3-month mortality, and modified Rankin Scale (mRS) scores.

Main Results:

  • Out of 10,436 patients, 429 (4.1%) were identified as SM.
  • SM patients had lower rates of PH (1.2% vs. 5.1%) and SICH (NINDS: 0.5% vs. 3.9%) compared to stroke patients.
  • SM patients demonstrated significantly better 3-month outcomes, with higher rates of mRS 0-1 (84.1% vs. 57.7%) and lower mortality (2.6% vs. 5.4%).

Conclusions:

  • Parenchymal hematoma and symptomatic intracerebral hemorrhage are uncommon following IVT in patients diagnosed with stroke mimics.
  • IVT appears to be a safe treatment option for selected patients with stroke mimics, with favorable outcomes.
Keywords:
cerebral infarctdiagnostic errorintracerebral hemorrhageischaemic strokestroke managementthrombolysis

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