Safety of thrombolysis in stroke mimics: results from a multicenter cohort study

Zinkstok, Sanne M.; Engelter, Stefan T.; Gensicke, Henrik; Lyrer, Philippe A.; Ringleb, Peter A.; Artto, Ville; Putaala, Jukka; Haapaniemi, Elena; Tatlisumak, Turgut; Chen, Yaohua; Leys, Didier; Sarikaya, Hakan; Michel, P.; Odier, Céline; Berrouschot, Jörg; Arnold, Marcel; Heldner, Mirjam Rachel; Zini, Andrea; Fioravanti, Valentina; Padjen, Visnja; ... (2013). Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke, 44(4), pp. 1080-1084. Lippincott Williams & Wilkins 10.1161/STROKEAHA.111.000126

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BACKGROUND AND PURPOSE Intravenous thrombolysis for acute ischemic stroke is beneficial within 4.5 hours of symptom onset, but the effect rapidly decreases over time, necessitating quick diagnostic in-hospital work-up. Initial time strain occasionally results in treatment of patients with an alternate diagnosis (stroke mimics). We investigated whether intravenous thrombolysis is safe in these patients. METHODS In this multicenter observational cohort study containing 5581 consecutive patients treated with intravenous thrombolysis, we determined the frequency and the clinical characteristics of stroke mimics. For safety, we compared the symptomatic intracranial hemorrhage (European Cooperative Acute Stroke Study II [ECASS-II] definition) rate of stroke mimics with ischemic strokes. RESULTS One hundred stroke mimics were identified, resulting in a frequency of 1.8% (95% confidence interval, 1.5-2.2). Patients with a stroke mimic were younger, more often female, and had fewer risk factors except smoking and previous stroke or transient ischemic attack. The symptomatic intracranial hemorrhage rate in stroke mimics was 1.0% (95% confidence interval, 0.0-5.0) compared with 7.9% (95% confidence interval, 7.2-8.7) in ischemic strokes. CONCLUSIONS In experienced stroke centers, among patients treated with intravenous thrombolysis, only a few had a final diagnosis other than stroke. The complication rate in these stroke mimics was low.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Arnold, Marcel and Heldner, Mirjam Rachel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

16 Jun 2014 14:45

Last Modified:

07 Aug 2017 08:38

Publisher DOI:

10.1161/STROKEAHA.111.000126

PubMed ID:

23444310

BORIS DOI:

10.7892/boris.53524

URI:

https://boris.unibe.ch/id/eprint/53524

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