| Abstract [eng] |
According to data from literature, the number of patients receiving intravenous thrombolysis in the emergency department who are later diagnosed with stroke mimics is increasing. This trend is influenced by intravenous thrombolysis application becoming more common and shortened door-to-needle time. The recognition of stroke mimics is crucial to avoid unnecessary use of intravenous thrombolysis and to ensure maximum patient safety. Aim of the study: To evaluate the use of intravenous thrombolysis in stroke mimics at the Republican Vilnius University Hospital and to compare their characteristics with those of patients treated with intravenous thrombolysis for acute ischemic stroke. Objectives: 1.To determine the frequency and etiology of stroke mimics. 2.To assess the demographic and clinical characteristics and comorbidities of stroke mimics. 3.To evaluate the use of intravenous thrombolysis in patients with stroke mimics. 4.To compare the characteristics and treatment outcomes of patients with stroke mimics and those with acute ischemic stroke. Methods: A retrospective analysis was conducted using a prospective database that included patients treated at the Republican Vilnius University Hospital in 2022 – 2023 who received intravenous thrombolysis in the emergency department. The patients were divided into two groups: those with acute ischemic stroke and those with stroke mimics. Within each group demographic data, clinical presentation, comorbidities, and thrombolysis administration were assessed. Results: The frequency of stroke mimics was 8%, with the most common causes being epilepsy (25%) and hypertensive encephalopathy (21,5%). Compared to patients with stroke mimics, patients with acute ischemic stroke were older (p < 0,001), more often presented with motor impairment (p = 0,019), and had a history of arterial hypertension (p = 0,007) and atrial fibrillation (p = 0,010). Stroke mimic patients more frequently reported dizziness (p = 0,048), had a history of migraine (p = 0,033) and lacked vascular risk factors (p = 0,044). The door-to-needle time was shorter in the acute ischemic stroke group (p = 0,044). Their condition 24 hours later, based on the NIH Stroke Scale, was worse (p = 0,01). No thrombolysis-related complications were observed in the stroke mimic group, while in the acute ischemic stroke group, the complication rate was 5,9%, though this difference was not statistically significant. ≤50 years of age and history of epilepsy were significant prognostic sign for stroke mimics. Motor impairment was found to be an independent symptom for acute ischemic stroke. Conclusions: Stroke mimics are not uncommon in the emergency department, however, their outcomes are more favorable than those of acute ischemic stroke, and complication rates are very low. In cases of diagnostic uncertainty, administering intravenous thrombolysis prior to establishing a definitive diagnosis is recommended. Further large-scale studies are necessary to improve the differentiation between stroke mimics and acute ischemic stroke. |
