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Thrombolysis of stroke mimics via telestroke

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 Sept...

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Autores principales: Lee, Vivien H, Howell, Ravyn, Yadav, Randheer, Heaton, Sharon, Wiles, Karen L, Lakhani, Sushil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240458/
https://www.ncbi.nlm.nih.gov/pubmed/35105730
http://dx.doi.org/10.1136/svn-2020-000776
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author Lee, Vivien H
Howell, Ravyn
Yadav, Randheer
Heaton, Sharon
Wiles, Karen L
Lakhani, Sushil
author_facet Lee, Vivien H
Howell, Ravyn
Yadav, Randheer
Heaton, Sharon
Wiles, Karen L
Lakhani, Sushil
author_sort Lee, Vivien H
collection PubMed
description 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.
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spelling pubmed-92404582022-07-20 Thrombolysis of stroke mimics via telestroke Lee, Vivien H Howell, Ravyn Yadav, Randheer Heaton, Sharon Wiles, Karen L Lakhani, Sushil Stroke Vasc Neurol Brief Report 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. BMJ Publishing Group 2022-02-01 /pmc/articles/PMC9240458/ /pubmed/35105730 http://dx.doi.org/10.1136/svn-2020-000776 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Brief Report
Lee, Vivien H
Howell, Ravyn
Yadav, Randheer
Heaton, Sharon
Wiles, Karen L
Lakhani, Sushil
Thrombolysis of stroke mimics via telestroke
title Thrombolysis of stroke mimics via telestroke
title_full Thrombolysis of stroke mimics via telestroke
title_fullStr Thrombolysis of stroke mimics via telestroke
title_full_unstemmed Thrombolysis of stroke mimics via telestroke
title_short Thrombolysis of stroke mimics via telestroke
title_sort thrombolysis of stroke mimics via telestroke
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240458/
https://www.ncbi.nlm.nih.gov/pubmed/35105730
http://dx.doi.org/10.1136/svn-2020-000776
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