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. 2022 Jun;7(3):267-270.
doi: 10.1136/svn-2020-000776. Epub 2022 Feb 1.

Thrombolysis of stroke mimics via telestroke

Vivien H Lee  1 , Ravyn Howell  2 , Randheer Yadav  2 , Sharon Heaton  2 , Karen L Wiles  2 , Sushil Lakhani  2
Affiliations

Thrombolysis of stroke mimics via telestroke

Vivien H Lee et al. Stroke Vasc Neurol. 2022 Jun.

Abstract

Background: The rate of intravenous tissue plasminogen activator (IVtPA) administered to stroke mimics (SM) occurs in 24%-44% of telestroke series.

Methods: We reviewed 270 suspected acute ischaemic stroke (AIS) patients who were evaluated by telestroke and received IVtPA from 1 July 2016 to 30 September 2017 at our academic comprehensive stroke centre.

Results: Among 270 AIS patients who received IVtPA via telestroke, 64 (23.7%) were diagnosed with SM. Compared with patients who had a stroke, the SM group was younger (mean age 56.4 vs 68.2, p<0.0001), more likely to be female (60.9% vs 45.6%, p=0.0324) and had longer door-to-needle times (85.3 vs 69.9, p=0.0008). The most common SM diagnoses were migraine 26 (40.6%), conversion disorder 12 (18.8%), encephalopathy 7 (10.9%) and unmasking (9.4%). Among the SM, migraine and conversion disorder were younger compared with the other subgroups (p<0.001). Functional exam elements were noted more frequently in conversion disorder (66.7%) and migraine (34.6%), but rare in other diagnoses (p=0.006). Among the SM, 23 (35.9%) had a history of a prior similar episodes, and 15 (23.4%) had a history of more than 5 spells.

Conclusions: In our telestroke programme, 23.7% of those administered thrombolysis had a final diagnosis of SM.

Keywords: stroke; thrombolysis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient inclusion. DWI, diffusion-weighted image; IVtPA, intravenous tissue plasminogen activator; ND, not done; TIA, transient ischemic attack.
See this image and copyright information in PMC

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