Abstract WP239: Stroke Mimics Treated with Thrombolysis: A Single Center Experience
Background: Recent reports suggested better outcomes associated with the drip-and-ship paradigm for acute ischemic stroke (AIS) treated with thrombolysis. Alternative hypothesis is a higher rate of stroke mimics (SM) among AIS treated in a non-specialized stroke centers and then transferred to comprehensive centers.
Methods: Consecutive patients treated with thrombolysis according to the admission criteria were reviewed in a single comprehensive stroke center over one academic year. Information on the basic demographic, hospital complications, psychiatric diagnoses, and discharge information were collected. We also identified those who were treated in outside facility and then transferred to the tertiary center (i.e. drip-and-ship paradigm). Comparative and adjusted analysis to identify predictors for stroke mimics was performed.
Results: 120 patients were treated with thrombolysis for AIS included in this analysis; 20 (16.7%) were discharged with the final diagnosis of SM; 14 of those had conversion syndrome and 6 patients had other syndromes (seizures, migraine, and hypoglycemia). Patients with SM were younger (55.6 ± 15.0 versus 69.4 ± 14.9, P = 0.0003), had a slight female preponderance (55% versus 46%; P = 0.46); and more likely to harbor a psychiatric diagnosis (45% versus 9%; P = <0.0001). Eighteen of 20 SM patients (90%) had the drip-and-ship treatment paradigm compared to 65% of those with AIS (P= 0.02). None of SM had any hemorrhagic complications and all were discharged to home. Predictors of SM on adjusted analysis included the drip-and-ship paradigm (OR 12.8, 95% CI 1.78, 92.1) and history of any psychiatric illness (OR 12.08; 95% CI 3.14, 46.4).
Conclusion: Drip-and-ship paradigm and the presence of any psychiatric history predict the diagnosis of SM. None of the SM had any thrombolysis related complication and all were discharged to home. These findings may explain the superior outcomes associated with the drip-and-ship paradigm in the treatment of AIS
- © 2012 by American Heart Association, Inc.