Description of stroke mimics after complete neurovascular assessment.
BACKGROUND
A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples.


OBJECTIVE
The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis.


METHODS
Prospective study including all patients admitted to a tertiary university hospital between June 2005 and April 2015 with a diagnosis of acute stroke. We analysed demographic data, cardiovascular risk factors, time from code stroke activation to admission, stroke severity (NIHSS), final destination after discharge, degree of disability (mRS), and treatment. We compared SM and ischaemic strokes. We ruled out patients with intracranial haemorrhage, subarachnoid haemorrhage, or other causes of SM that may be detected on the baseline CT scan.


RESULTS
Four hundred four of the 4,570 included patients (8.8%) were found to have SM. Patients with SM were younger (70.3 vs. 74, P<.0001), less likely to exhibit cardiovascular risk factors and atrial fibrillation (13 vs. 34%, P<.0001), scored lower on the NIHSS at baseline (2 vs. 4, P<.0001), and included fewer cases of aphasia (9.4 vs. 19.6%, P<.02) and dysphagia (1.2 vs. 17%, P<.0001) than patients with stroke. SM caused fewer code stroke activations (28 vs. 40%, P<.0001). Patients with SM required shorter hospital stays (4.9 vs. 7.8 days, P<.0001), were less frequently admitted to the stroke unit (47 vs. 60%, P<.0001) and more frequently discharged home (95 vs. 62%, P<.0001), and had better outcomes (mRS scores 0-2; 76 vs. 54%, P<.0001). Intravenous fibrinolysis was administered to 4.7% of these patients. Epileptic seizures were the most frequent cause of SM (26%).


CONCLUSIONS
In our sample, 8.8% of all diagnoses of ischaemic stroke were SM. These events have different demographic, clinical, and prognostic characteristics; epilepsy is the most common aetiology. Despite receiving specialised emergency care, 19 patients with SM (4.7%) were treated with intravenous fibrinolysis.
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España.
C
C
Avellaneda-Gómez
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: 92269@hospitaldelmar.cat.
A
A
Rodríguez Campello
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
E
E
Giralt Steinhauer
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España.
A
A
Gómez González
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España.
M
M
Serra Martínez
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España.
P
P
de Ceballos Cerrajería
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España.
A
A
Zabalza de Torres
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
E
E
Cuadrado-Godia
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
A
A
Ois Santiago
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
J
J
Jiménez-Conde
Unidad de Ictus, Servicio de Neurología, Hospital del Mar, Barcelona, España; Grupo de Investigación Neurovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
J
J
Roquer
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D062606:Tertiary Care Centers; D016896:Treatment Outcome
Acute stroke; Crisis epiléptica; Código Ictus; Epileptic seizures; Fibrinolysis; Fibrinólisis; Ictus agudo; Ictus isquémico; Ischaemic stroke; Stroke Code; Stroke mimic