Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code.

Autor: Gonzalez-Martinez A; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain., Trillo S; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain., Benavides-Bernaldo de Quirós C; Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain., Casado-Fernández L; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain., De Toledo M; Epilepsy Unit, Department of Neurology, Hospital Universitario de la Princesa, Madrid, Spain., Barbosa-Del Olmo A; Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain., Vega Piris L; Methodological Support Unit, Hospital Universitario de La Princesa, Madrid, Spain., Ramos C; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain., Manzanares-Soler R; Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain., Ximénez-Carrillo Á; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain., Vivancos J; Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2021 Jun; Vol. 28 (6), pp. 1939-1948. Date of Electronic Publication: 2021 Mar 13.
DOI: 10.1111/ene.14783
Abstrakt: Background and Purpose: Stroke mimics (SMs) account for a significant number of patients attended as stroke code (SC) with an increasing number over the years. Recent studies show perfusion computed tomography (PCT) alterations in some SMs, especially in seizures. The objective of our study was to evaluate the clinical characteristics and PCT alterations in SMs attended as SC in order to identify potential predictors of PCT alterations in SMs.
Methods: A retrospective study was performed including all SC activations undergoing a multimodal CT study including non-enhanced computed tomography (CT), CT angiography and PCT, as part of our SC protocol, over 39 months. Patients with a final diagnosis of SM after complete diagnosis work-up were therefore selected. Clinical variables, diagnosis, PCT alteration patterns and type of map affected (T max or time to peak, cerebral blood flow and cerebral blood volume) were registered.
Results: Stroke mimics represent up to 16% (284/1761) of SCs with a complete multimodal study according to our series. Amongst SMs, 26% (74/284) showed PCT alterations. PCT abnormalities are more prevalent in seizures and status epilepticus and the main pattern is alteration of the time to peak map, of unilateral hemispheric distribution or of non-vascular territory. In our series, the independent predictors of alteration in PCT in SMs are aphasia, female sex and older age.
Conclusions: Perfusion computed tomography alterations can be found amongst almost a third of SMs attended as SC, especially older women presenting with aphasia with a final diagnosis of epileptic seizures and status epilepticus.
(© 2021 European Academy of Neurology.)
Databáze: MEDLINE
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