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Review
. 2021 Feb;11(1):64-68.
doi: 10.1212/CPJ.0000000000000828.

Munchausen Syndrome by Tissue Plasminogen Activator: Patients Seeking Thrombolytic Administration

Rafer Willenberg  1 , Bo Leung  1 , Shlee Song  1 , Oana M Dumitrascu  1 , Konrad Schlick  1 , Patrick Lyden  1
Affiliations
Review

Munchausen Syndrome by Tissue Plasminogen Activator: Patients Seeking Thrombolytic Administration

Rafer Willenberg et al. Neurol Clin Pract. 2021 Feb.

Abstract

Purpose of review: Munchausen syndrome by tissue plasminogen activator (tPA) is a phenomenon we describe as patients exhibiting factitious symptoms to assume the role of the sick patient, desiring and received tPA, with no alternative diagnosis or secondary gain to better account for their presentation. To illustrate this phenomenon and its magnitude, we present a series of cases of Munchausen syndrome by tPA, prevalence in our stroke center, and highlight one illustrative case.

Recent findings: Of 335 cases with tPA administration over 29 months, 10 were confirmed as Munchausen syndrome by tPA, reflecting a 3.0% prevalence in our stroke center.

Summary: Munchausen syndrome by tPA is an underappreciated phenomenon encountered in evaluating patients with acute stroke symptoms. Administering tPA in Munchausen syndrome poses an ethical dilemma because standard of care favors rapid tPA administration, but administration can cause harm, burdens the healthcare system, and does not treat the patient's Munchausen syndrome.

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Comment in

  • Ethical Issues in Stroke Management.
    Bernat JL, Lukovits TG. Bernat JL, et al. Neurol Clin Pract. 2021 Feb;11(1):3-5. doi: 10.1212/CPJ.0000000000000925. Neurol Clin Pract. 2021. PMID: 33970165 Free PMC article. No abstract available.

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