title: A model to prevent fibrinolysis in patients with stroke mimics.
abstract: BACKGROUND
  Many patients with stroke-mimicking conditions receive treatment with intravenous fibrinolysis (IVF), a treatment associated with potentially serious complications. We sought to determine if any clinical or radiographic characteristics can help predict stroke mimics among IVF candidates.
  
  
  METHODS
  This retrospective study was carried out at a single institution. Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA; n = 193) were divided into 3 categories: acute ischemic stroke (n = 142), aborted stroke (n = 21), and stroke mimics (n = 30). Analysis of variance and the chi-square test were used to assess differences, while logistic regression models were computed to predict groups.
  
  
  RESULTS
  Mimics treated with rt-PA did not experience complications (intracranial bleeding, systemic hemorrhage, or angioedema), and had better neurologic and functional outcomes than stroke patients (P < .05). Several variables helped differentiate strokes from mimics, including atherosclerosis on computed tomographic angiography (odds ratio [OR] 23.6; 95% confidence interval [CI] 8.4-66.2), atrial fibrillation (OR 11.4; 95% CI 1.5-86.3), age >50 years (OR 7.2; 95% CI 2.8-18.5), and focal weakness (OR 4.15; 95% CI 1.75-9.8). Other variables decreased chances of stroke: migraine history (OR 0.05; 95% CI 0.01-0.4), epilepsy (OR 0.13; 95% CI 0.02-0.8), paresthesia (OR 0.1; 95% CI 0.04-0.3), and precordialgia (OR 0.045; 95% CI 0.002-0.9). A regression model using focal weakness, computed tomographic angiography findings, and precordialgia had a 90.2% predictive accuracy.
  
  
  CONCLUSIONS
  IVF has low complication rates in stroke mimics. Certain clinical characteristics appear predictive of stroke mimics, particularly normal computed tomographic angiography. If confirmed, this may help prevent giving IVF to patients without stroke.
authors.affiliation: Division of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Chang
authors.forename: Mohamed
authors.initials: M
authors.lastname: Teleb
authors.forename: Julian P
authors.initials: JP
authors.lastname: Yang
authors.forename: Yazan J
authors.initials: YJ
authors.lastname: Alderazi
authors.forename: Kristina
authors.initials: K
authors.lastname: Chapple
authors.forename: James L
authors.initials: JL
authors.lastname: Frey
authors.forename: Lucas
authors.initials: L
authors.lastname: Restrepo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced; D001130:Arizona; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D002533:Cerebral Angiography / Q000379:methods; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator