Stroke Mimics in a Stroke Care Pathway Based on MRI Screening

Autor: Raoul Pop, Christian Marescaux, Véronique Quenardelle, Bernard Geny, Valérie Wolff, Nicolas Meyer, Valérie Lauer-Ober, Rémy Beaujeux, Olivier Rouyer, Hervé Delplancq, Stéphane Kremer, Ielyzaveta Zinchenko, Marc Bataillard
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Tissue plasminogen activator
Magnetic resonance angiography
030218 nuclear medicine & medical imaging
Diagnosis
Differential
Young Adult
03 medical and health sciences
0302 clinical medicine
Physical medicine and rehabilitation
Fibrinolytic Agents
Predictive Value of Tests
Internal medicine
medicine
Humans
Thrombolytic Therapy
Prospective Studies
Young adult
Prospective cohort study
Stroke
Aged
Aged
80 and over
Neurologic Examination
medicine.diagnostic_test
business.industry
Brain
Middle Aged
medicine.disease
Cerebral Angiography
Neurology
Critical Pathways
Cardiology
Female
Neurology (clinical)
Differential diagnosis
Cardiology and Cardiovascular Medicine
business
Magnetic Resonance Angiography
030217 neurology & neurosurgery
Fibrinolytic agent
medicine.drug
Cerebral angiography
Zdroj: Cerebrovascular Diseases. 42:205-212
ISSN: 1421-9786
1015-9770
Popis: Background: Since the use of tissue plasminogen activator for acute ischemic stroke (IS), stroke care pathways have been developed for patients with suspicion of acute stroke. The aim of this prospective observational study was to analyze the stroke mimic (SM) characteristics in patients who were part of our stroke care pathway. Methods: All consecutive patients admitted in the code stroke within a 1-year period were prospectively enrolled in this study. Patients with a sudden onset of neurological focal deficit in a time window less than 4H30 as indicated for intravenous thrombolysis, had been accepted in the pathway by a neurologist who was directly contactable by the prehospital emergency medical service 24 h per day. Patients arrived directly on the MRI site without passing by the emergency department. A clinical neurological evaluation and a brain MRI with tri-dimensional time-of-flight magnetic resonance angiography were performed. The FAST score was calculated a posteriori. The final discharge diagnosis was concluded either immediately after both neurological examination and cerebrovascular neuroimaging or after other relevant investigations. We classified the discharge diagnosis into neurovascular diseases (NVDs) and into SM. Results: There were 1,361 consecutive patients admitted for suspicion of acute stroke. Sixty-two percent (n = 840) had an NVD including IS (n = 529), transient ischemic attacks (n = 236), intracranial hemorrhages (n = 68), cerebral venous thrombosis (n = 3) and neurovascular medullar pathologies (n = 4). SM represented 38% of cases (n = 521) and the most frequent discharge diagnosis was defined as headaches (18.6%), psychological disorders (16.7%), peripheral vertigo (11.9%) and epilepsy (10.6%). The comparison between the characteristics of the NVD and those of the SM groups showed some significant differences: in the SM group, women were more represented, patients were younger and the NIHSS was lower than in the NVD group. All cardiovascular risk factors were more represented in the NVD group. Concerning the symptoms, motor deficit, speech disturbances, homonymous lateral hemianopia and head and gaze deviation were more represented in the NVD group, whereas vertigo, non-systematized visual trouble, headache, confusion, weakness, neuropsychological symptoms, seizure and chest pain were significantly more frequent in the SM group. The negative predictive value of the FAST score was 64% and the positive predictive value was 76%. Conclusions: A rate of SM up to 38% of the code stroke system confirms the difficulty to distinguish clinically a stroke from another diagnosis. In this study, using cerebral MRI in first intention was of special interest in patients with acute neurological symptoms to differentiate an NVD from an SM.
Databáze: OpenAIRE
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