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Migraine History: A Predictor of Negative Diffusion-Weighted Imaging in IV-tPA-Treated Stroke Mimics
Jussie Lima1, Tapan Mehta1, Neil Datta1
1Ayer Neuroscience Institute, Hartford HealthCare, Hartford Hospital, Hartford, Connecticut; University of Connecticut, Hartford, Connecticut.
Background:
Migraine, seizures, and psychiatric disorders are frequently reported as "stroke mimics" in patients with negative diffusion-weighted imaging (DWI) after IV-tPA. We sought to determine predictors of negative DWI in suspected stroke patients treated with IV-tPA.
Method:
A retrospective case-control study encompassing all acute stroke patients treated with IV-tPA (at our hospital or "dripped and shipped") from January 2013 to December 2014 was con- ducted. A total of 275 patients were identified with 47 negative DWI cases and 228 positive DWI controls. Variables including demographic factors, stroke characteristics, and clinical comorbidities were analyzed for statistical significance. A multivariate logistic regression was performed (SPSS-24) to identify predictors of negative DWI.
Results:
Approximately 17% of patients had negative DWI after IV-tPA. Compared to controls, migraine history independently predicted negative DWI (odds ratio [OR] 5.0 95% confidence interval [CI] 1.03-24.6, P = .046). Increasing age (OR .97 95% CI .94-.99, P = .02) and atrial fibrillation (OR .25 95% CI .08-.77, P = .01) predicted lower probability of negative DWI. Gender, admission NIHSS, treatment location, preadmission modified Rankin scale, diabetes mellitus, hypertension, hyperlipidemia, symptom side, seizure history, and psychiatric history did not predict negative DWI status.
Conclusions:
In our study, roughly 1 in 6 patients treated with IV-tPA were later found to be stroke mimics with negative DWI. Despite a high proportion of suspected stroke mimics in our study, only preexisting migraine history independently predicted negative DWI status after IV-tPA treatment in suspected stroke patients.
Insights
Migraine history predicts negative diffusion-weighted imaging (DWI) in stroke mimics receiving IV-tPA. About 17% of patients treated for stroke had negative DWI, suggesting mimic conditions.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Stroke mimics, including migraine, seizures, and psychiatric disorders, are often misdiagnosed in patients with negative diffusion-weighted imaging (DWI) after intravenous thrombolysis (IV-tPA).
- Accurate identification of stroke mimics is crucial for appropriate patient management and resource allocation.
Purpose of the Study:
- To identify predictors of negative DWI in patients suspected of acute stroke and treated with IV-tPA.
- To differentiate true stroke from stroke mimics in the acute treatment setting.
Main Methods:
- A retrospective case-control study analyzed 275 acute stroke patients treated with IV-tPA between January 2013 and December 2014.
- Data included demographic factors, stroke characteristics, and comorbidities; multivariate logistic regression identified predictors of negative DWI.
Main Results:
- Approximately 17% of patients exhibited negative DWI post-IV-tPA.
- Migraine history was an independent predictor of negative DWI (OR 5.0, P=.046).
- Increasing age and atrial fibrillation predicted a lower probability of negative DWI.
Conclusions:
- A significant proportion of patients treated with IV-tPA for suspected stroke were found to have negative DWI, indicating stroke mimics.
- Preexisting migraine history was the only independent predictor of negative DWI in this cohort, highlighting its importance in differential diagnosis.
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