Intravenous tissue plasminogen activator in functional stroke mimics

Area of Science:

• Neurology
• Neuroscience
• Emergency Medicine

Background:

• Functional neurological disorders, including functional stroke mimics (FSM), are increasingly diagnosed.
• Pathophysiology and mechanisms of FSM are poorly understood.
• FSM diagnosis is challenging due to overlapping symptoms with stroke, especially under time pressure.

Purpose of the Study:

• To highlight the challenges neurologists face in diagnosing FSM in acute ischemic stroke settings.
• To emphasize the importance of accurate diagnosis and appropriate treatment for FSM patients.
• To discuss the implications of misdiagnosis, including unnecessary thrombolytic therapy.

Main Methods:

• Review of diagnostic criteria for FSM.
• Analysis of clinical indicators for distinguishing FSM from stroke.
• Discussion of treatment strategies for FSM.

Main Results:

• Intravenous thrombolytic therapy may be safe for FSM but carries potential risks.
• Effective long-term treatment for FSM is still unknown.
• Distinguishing FSM from stroke requires careful examination of symptoms and clinical findings.

Conclusions:

• FSM should be diagnosed using established criteria.
• Electronic health information exchange is vital to prevent unnecessary thrombolytic treatments in FSM patients.
• Long-term management of FSM involves communication, psychoeducation, and physiotherapy.