Original ArticleA Model to Prevent Fibrinolysis in Patients with Stroke Mimics
Section snippets
Study Design
Records from all patients treated with rt-PA from 2007 to 2008 at a tertiary referral center were retrospectively reviewed. The local institutional review board approved this study. Patients were divided into 3 groups: AIS, stroke mimics, and aborted AIS (AbS). AIS was defined as sudden focal neurologic dysfunction with evidence of acute brain ischemia on diffusion-weighted images (DWIs) or serial head computed tomographic (CT) scans. AbS was defined as instances of sudden focal neurologic
Characteristics of Study Subjects
Of 193 patients receiving IV rt-PA, 142 had AIS, 21 had AbS, and 30 had mimics. MRI scans were not obtained in 30 AIS patients. Of these, 27 had large artery occlusion on CTA or MRA, 1 had evolving hypodensities on serial head CT scan, and no reasons were stated for not pursuing MRI in the remaining cases. Five stroke mimics did not receive MRI: 1 left against medical advice, 1 had a pacemaker, and no reasons were stated for the remainder. Two AbS patients did not receive MRI, both because of
Discussion
These data suggest that it is possible to identify stroke mimics using several clinical variables that are usually available on initial evaluation in the emergency room. Focal weakness, history of AF, and abnormal CTA increased the odds of actual stroke, whereas a history of migraine or epilepsy and complaints of paresthesia increased chances of a stroke mimic. Three variables—atherosclerotic changes on CTA, focal weakness, and chest pain—had high accuracy at forecasting AIS. The described
Acknowledgments
We are indebted to Dr. Jeffrey Saver for his thoughtful comments.
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