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Intravenous thrombolysis in stroke mimics: results from the SITS International Stroke Thrombolysis Register.
Keselman, B; Cooray, C; Vanhooren, G; Bassi, P; Consoli, D; Nichelli, P; Peeters, A; Sanak, D; Zini, A; Wahlgren, N; Ahmed, N; Mazya, M V.
Afiliación
  • Keselman B; Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • Cooray C; Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • Vanhooren G; Department of Neurology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
  • Bassi P; Neurological Department, San Giuseppe Hospital, Milan.
  • Consoli D; Department of Neurology, Iazzolino Hospital, Vibo Valentia.
  • Nichelli P; Stroke Unit Neurology Clinic, Department of Neuroscience, Ospedale Civile S. Agostino Estense, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
  • Peeters A; Department of Neurology, Cliniques Universitaires St-Luc, Brussels, Belgium.
  • Sanak D; Comprehensive Stroke Centre, Department of Neurology, Palacký University Hospital, Olomouc, Czech Republic.
  • Zini A; Stroke Unit Neurology Clinic, Department of Neuroscience, Ospedale Civile S. Agostino Estense, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy.
  • Wahlgren N; Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • Ahmed N; Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • Mazya MV; Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Eur J Neurol ; 26(8): 1091-1097, 2019 08.
Article en En | MEDLINE | ID: mdl-30793434
BACKGROUND AND PURPOSE: Patients with stroke mimics (SM), i.e. conditions with stroke-like symptoms, may risk harm if treated with intravenous thrombolysis (IVT). Current guidelines state low risk of intracerebral hemorrhage based on studies comprising a total of <400 SM cases. We aimed to compare safety and outcomes following IVT between patients with acute ischaemic stroke and mimicking conditions. METHODS: We included IVT-treated ischaemic stroke patients in the SITS International Stroke Thrombolysis Register 2003-2017, examined with magnetic resonance imaging 22-36 h after treatment. Outcomes were parenchymal hematoma (PH) after treatment, symptomatic intracerebral hemorrhage (SICH) per Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST), Second European Co-operative Stroke Study (ECASS II) and National Institutes of Neurological Disorders and Stroke Study (NINDS) criteria, death and modified Rankin Scale score (mRS) at 3 months. RESULTS: Of 10 436 patients, 429 mimics (4.1%) were identified. The most common types were functional (30.8%), migraine (17.5%) and seizure (14.2%). Patients with mimics had fewer cerebrovascular risk factors and lower median National Institutes of Health Stroke Scale score [7 (interquartile range, 5-10) vs. 8 (5-14), P < 0.001]. Among mimics versus stroke patients, PH was seen in 1.2% vs. 5.1% (P < 0.001), SICH NINDS in 0.5% vs. 3.9% (P < 0.001), SICH ECASS II in 0.2% vs. 2.1% (P = 0.007) and SICH SITS-MOST in 0% vs. 0.5% (P = 0.28). Modified Rankin Scale score 0-1 at 3 months was present in 84.1% vs. 57.7% (P < 0.001) and death within 3 months in 2.6% vs. 5.4% (P = 0.028) of mimics and stroke patients, respectively. CONCLUSIONS: This large observational study indicated that PH and SICH following IVT in patients with SM are uncommon.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Convulsiones / Terapia Trombolítica / Isquemia Encefálica / Activador de Tejido Plasminógeno / Accidente Cerebrovascular / Fibrinolíticos / Trastornos Migrañosos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Neurol Asunto de la revista: NEUROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Convulsiones / Terapia Trombolítica / Isquemia Encefálica / Activador de Tejido Plasminógeno / Accidente Cerebrovascular / Fibrinolíticos / Trastornos Migrañosos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Neurol Asunto de la revista: NEUROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Reino Unido