title: A Retrospective Cohort Study on the Use of Intravenous Thrombolysis in Stroke Mimics.
abstract: BACKGROUND
  The urgency of intravenous thrombolysis in acute ischemic stroke can lead to inadvertent thrombolysis of patients with nonstroke diagnoses (stroke mimics), increasing the risk of adverse events. The objectives of this study were to compare thrombolysed acute ischemic stroke and stroke mimic cases based on demographic factors, physiological parameters, radiological findings, and clinical presentation, and to evaluate the clinical implications of thrombolysing stroke mimics.
  
  
  METHODS
  A retrospective analysis of a single-center database of all thrombolysed strokes and mimics over a period greater than 3 years. Diagnoses were confirmed by expert consensus after a review of clinical factors and imaging. Intercohort variation was assessed using Wilcoxon rank-sum or Pearson's chi-square test.
  
  
  RESULTS
  The stroke mimic cohort tended to be younger (mean age 59.9 years versus 73.7 years, P < .001) and had a lower National Institutes of Health Stroke Score at presentation (mean 5.9 points versus 6.4 points, P < .01). However, the time taken from the onset of symptoms to delivery of thrombolytic drugs was longer in the mimic cohort (mean time 170 minutes versus 138 minutes, P < .01). Any differences in blood glucose (P = .07), time taken from hospital arrival to delivery of intravenous thrombolysis (P = .57), and blood pressure on admission (systolic, P = .09 and diastolic, P = .34) were not statistically significant. No adverse events were reported in the mimic cohort.
  
  
  CONCLUSIONS
  Despite similarities in clinical presentation, thrombolysed stroke mimics are of a different physiological and demographic population, and are associated with fewer adverse events compared with thrombolysed acute ischemic stroke patients.
authors: Imperial College Healthcare NHS Trust, London, UK.
authors: Prasanthi
authors: P
authors: Sivakumaran
authors: Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK. Electronic address: dipender.gill@imperial.ac.uk.
authors: Dipender
authors: D
authors: Gill
authors: Imperial College Healthcare NHS Trust, London, UK.
authors: Gheed
authors: G
authors: Mahir
authors: University College London Hospitals NHS Foundation Trust, London, UK.
authors: Aravindhan
authors: A
authors: Baheerathan
authors: Imperial College Healthcare NHS Trust, London, UK.
authors: Arindam
authors: A
authors: Kar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents
keywords: Thrombolysis; acute ischemic stroke; adverse events; stroke mimics; t-PA