Can rt-PA be administered to the wrong patient? Two patients with somatoform disorder.
BACKGROUND
Intravenous rt-PA (i.v. rt-PA) for acute stroke has raised many concerns, including its inadvertent use in patients presenting with acute stroke-like symptoms as the expression of their somatoform disorder. Diagnosis of the somatoform disorder is often delayed, and thrombolytics in these patients for their stroke-like presentation subjects them to risk for hemorrhage.


METHODS
The presentation, neurological findings, and the therapeutic decision making was audited in 85 patients who received i.v. rt-PA for a diagnosis of acute stroke. All the surviving patients were re-examined neurologically at least three months after i.v. rt-PA. Baseline and follow-up brain CT scans were re-reviewed by a neuroradiologist who was blinded to clinical presentation and outcome. Patients whose clinical presentation, brain CT and neurological outcome did not fit into known or expected anatomical and clinical patterns of stroke underwent psychological assessment using the Minnesota Multiphasic Personality Inventory-2.


RESULTS
In two patients three stroke-like presentations of somatoform disorder inadvertently were treated with i.v. rt-PA. This was primarily caused by abbreviated neurological examination and narrow differential diagnosis.


CONCLUSIONS
Patients with somatoform disorder may present with symptoms mimicking acute stroke. Under the time constraints of i.v. rt-PA use, a diagnosis of somatoform disorder can be missed, subjecting such patients to the potential complications of thrombolytics.
Mouradian
Mikael S
MS
Division of Neurology, Department of Medicine, Queens University, Kingston, Ontario, Canada.
Rodgers
Jennifer
J
Kashmere
Jodi
J
Jickling
Glen
G
McCombe
Jennifer
J
Emery
Derek J
DJ
Demchuk
Andrew M
AM
Shuaib
Ashfaq
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy*; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator