Intravenous tissue plasminogen activator in functional stroke mimics

Time pressure in the treatment of acute ischemic stroke patients generates difficult decisions for neurologists, sometimes resulting in stroke mimic patients receiving intravenous thrombolytic therapy. Proper diagnosis and appropriate treatment for these patients are crucial, yet incredibly challenging in cases of functional stroke mimics (FSM).

Functional neurological disorders, including FSM, are increasingly diagnosed. However, their pathophysiology and underlying mechanisms are poorly understood, even though the diagnostic criteria for diagnosing FSM exist, and various clinical indicators support them. Functional neurological symptoms often result in serious disability for patients but the effective treatment is unknown. Neurologists need to examine the symptoms and the key clinical findings to distinguish between FSM and stroke. The intravenous thrombolytic therapy appears safe for FSM, but the potential harm of thrombolysis should be a concern. FSMdiagnosed patients require long-term treatment, starting with open and clear communication about their condition and followed by psychoeducation and physiotherapy.

FSM should be diagnosed using the diagnostic criteria. Electronic health information exchange among healthcare providers is necessary to avoid unnecessary thrombolytic treatments in this group of patients.