title: Safety and outcomes of intravenous thrombolysis in stroke mimics: a 6-year, single-care center study and a pooled analysis of reported series.
abstract: OBJECTIVE
  Efforts to increase the availability and shorten the time delivery of intravenous thrombolysis in patients with acute ischemic stroke carry the potential for tissue plasminogen activator administration in patients with diseases other than stroke, that is, stroke mimics (SMs). We aimed to determine safety and to describe outcomes of intravenous thrombolysis in SM.
  
  
  METHODS
  We retrospectively analyzed stroke registry data of consecutive acute ischemic stroke admissions treated with intravenous thrombolysis over a 6-year-period. The admission National Institutes of Health Stroke Scale score, vascular risk factors, ischemic lesions on brain MRI (routinely performed as part of diagnostic work-up), and discharge modified Rankin Scale scores were documented. Initial stroke diagnosis in the emergency department was compared with final discharge diagnosis. SM diagnosis was based on the absence of ischemic lesions on diffusion-weighted imaging sequences in addition to an alternate discharge diagnosis. Symptomatic intracranial hemorrhage was defined as brain imaging evidence of intracranial hemorrhage with clinical worsening by National Institutes of Health Stroke Scale score increase of ≥4 points.
  
  
  RESULTS
  Intravenous thrombolysis was administered in 539 patients with acute ischemic stroke (55% men; mean age, 66 ± 15 years). Misdiagnosis of acute ischemic stroke was documented in 56 cases (10.4%; 95% CI, 7.9% to 13.3%). Conversion disorder (26.8%), complicated migraine (19.6%), and seizures (19.6%) were the 3 most common final diagnoses in SM. SMs were younger (mean age, 56 ± 13 years) and had milder baseline stroke severity (median National Institutes of Health Stroke Scale, 6; interquartile range, 4) compared with patients with confirmed acute ischemic stroke (mean age, 67 ± 14 years; median National Institutes of Health Stroke Scale, 8; interquartile range, 10; P<0.001). There was no case of symptomatic intracranial hemorrhage in SMs (0%; 95% CI, 0% to 5.5%); 96% of SMs were functionally independent at hospital discharge (modified Rankin Scale, 0 to 1).
  
  
  CONCLUSIONS
  Our single-center data indicate favorable safety and outcomes of intravenous thrombolysis administered to SM.
authors.affiliation: Comprehensive Stroke Center, University of Alabama at Birmingham, RWUH M226, 1530 3rd Avenue S, Birmingham, AL 35294, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: Jason
authors.initials: J
authors.lastname: Chang
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Steven L
authors.initials: SL
authors.lastname: Hoover
authors.forename: Annabelle Y
authors.initials: AY
authors.lastname: Lao
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Elefterios
authors.initials: E
authors.lastname: Stamboulis
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.forename: Marc D
authors.initials: MD
authors.lastname: Malkoff
authors.forename: James L
authors.initials: JL
authors.lastname: Frey
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents