title: Safety of thrombolysis in stroke mimics: results from a multicenter cohort study.
abstract: OBJECTIVE
  Intravenous thrombolysis for acute ischemic stroke is beneficial within 4.5 hours of symptom onset, but the effect rapidly decreases over time, necessitating quick diagnostic in-hospital work-up. Initial time strain occasionally results in treatment of patients with an alternate diagnosis (stroke mimics). We investigated whether intravenous thrombolysis is safe in these patients.
  
  
  METHODS
  In this multicenter observational cohort study containing 5581 consecutive patients treated with intravenous thrombolysis, we determined the frequency and the clinical characteristics of stroke mimics. For safety, we compared the symptomatic intracranial hemorrhage (European Cooperative Acute Stroke Study II [ECASS-II] definition) rate of stroke mimics with ischemic strokes.
  
  
  RESULTS
  One hundred stroke mimics were identified, resulting in a frequency of 1.8% (95% confidence interval, 1.5-2.2). Patients with a stroke mimic were younger, more often female, and had fewer risk factors except smoking and previous stroke or transient ischemic attack. The symptomatic intracranial hemorrhage rate in stroke mimics was 1.0% (95% confidence interval, 0.0-5.0) compared with 7.9% (95% confidence interval, 7.2-8.7) in ischemic strokes.
  
  
  CONCLUSIONS
  In experienced stroke centers, among patients treated with intravenous thrombolysis, only a few had a final diagnosis other than stroke. The complication rate in these stroke mimics was low.
authors: Department of Neurology, Academic Medical Center University of Amsterdam, Amsterdam, the Netherlands.
authors: Sanne M
authors: SM
authors: Zinkstok
authors: Stefan T
authors: ST
authors: Engelter
authors: Henrik
authors: H
authors: Gensicke
authors: Philippe A
authors: PA
authors: Lyrer
authors: Peter A
authors: PA
authors: Ringleb
authors: Ville
authors: V
authors: Artto
authors: Jukka
authors: J
authors: Putaala
authors: Elena
authors: E
authors: Haapaniemi
authors: Turgut
authors: T
authors: Tatlisumak
authors: Yaohua
authors: Y
authors: Chen
authors: Didier
authors: D
authors: Leys
authors: Hakan
authors: H
authors: Sarikaya
authors: P
authors: P
authors: Michel
authors: Céline
authors: C
authors: Odier
authors: Jörg
authors: J
authors: Berrouschot
authors: Marcel
authors: M
authors: Arnold
authors: Mirjam R
authors: MR
authors: Heldner
authors: Andrea
authors: A
authors: Zini
authors: Valentina
authors: V
authors: Fioravanti
authors: Visnja
authors: V
authors: Padjen
authors: Ljiljana
authors: L
authors: Beslac-Bumbasirevic
authors: Alessandro
authors: A
authors: Pezzini
authors: Yvo B
authors: YB
authors: Roos
authors: Paul J
authors: PJ
authors: Nederkoorn
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator