Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code
Alicia Gonzalez-Martinez1, Santiago Trillo1, Carmen Benavides-Bernaldo de Quirós2
1Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
European Journal of Neurology
|February 20, 2021
Summary
Stroke mimics, often mistaken for stroke, can show changes on perfusion computed tomography (PCT) scans. Older women with aphasia and seizures are more likely to have these PCT alterations.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Stroke mimics (SMs) constitute a significant and growing proportion of patients evaluated under stroke code (SC) protocols.
- Perfusion computed tomography (PCT) has revealed alterations in some SMs, particularly in cases of seizures.
Purpose of the Study:
- To investigate the clinical characteristics of SMs evaluated under SC protocols.
- To identify alterations in PCT findings within SMs.
- To determine predictors of PCT alterations in SMs.
Main Methods:
- A retrospective analysis of patients undergoing multimodal CT, including PCT, as part of SC protocol.
- Selection of patients with a confirmed diagnosis of SM after comprehensive work-up.
- Registration of clinical variables, diagnosis, PCT alteration patterns, and affected maps (Tmax, CBF, CBV).
Main Results:
- SMs accounted for 16% of SC activations with complete multimodal CT studies.
- Twenty-six percent of SMs exhibited PCT alterations.
- PCT abnormalities were most common in seizures and status epilepticus, often affecting the Tmax map with unilateral or non-vascular territory distribution.
- Independent predictors for PCT alterations in SMs included aphasia, female sex, and older age.
Conclusions:
- Perfusion computed tomography alterations are observed in nearly one-third of SMs managed under SC protocols.
- Older women presenting with aphasia and diagnosed with epileptic seizures or status epilepticus are particularly associated with PCT abnormalities.
