Abstract WP238: Safety and Outcomes of Stroke Mimics After Thrombolysis: A Single Center Experience

Abstract

Background: Administration of intravenous (IV) t-PA for acute ischemic stroke (AIS) improves outcomes. The most dreaded complication is intracerebral hemorrhage (ICH). Some patients have symptoms that impersonate an AIS but are later found to have an alternate diagnosis; these are termed stroke mimics (SM). SM treated with IV t-PA are exposed to hemorrhagic complications without benefit. Objectives: To describe the characteristics, safety, and outcomes of SM patients treated with t-PA under 4.5 hours. Methods: We reviewed all patients hospitalized after IV t-PA treatment at a tertiary care hospital and primary stroke center from January 2008 through December 2011. SMs were determined by review of clinical and imaging findings. SM are described and compared to t-PA treated patients with AIS for demographics, ICH, bleeding complications, and outcomes. Results: We identified 38 SM (12%) and 285 AIS (88%) t-PA treated patients. Compared to AIS, SM patients were younger (55.1 vs. 67.0 yrs, p<.001), more often women (68% vs.49%, p=.025), and reported a history of stroke more often (45% v 14%, p<.001). There were no differences in race, baseline stroke scale (9.4 v 10.9, p=.26), or onset to treatment time (164 min v 159 min, p=.63); 12 SM were in the 3-4.5 hour window. There were no ICHs or deaths in SM patients. There were two (5.2%) SM systemic hemorrhages; a femoral artery bleed post cardiac catheterization requiring transfusion, and an UGI bleed after a nasogastric tube not requiring transfusion. The average SM length of stay was 3.4 +/- 2.2 days. The mean discharge NIHSS score was 1.3 +/-2.5 in the SM v 4.6+/-5.7 in the AIS patients (p<.001). SM discharges were: home (84%), rehab center (12%), Nursing home 3%, and other (3%). The most common cause of SM was conversion disorder (47%) seizures (32 %) and migraine (8%). Conclusion: SM are not uncommon. Treatment of SM with IV t-PA appears to be safe in this cohort. The most common etiologies of stroke mimics were conversion disorder, seizures, and migraine. These results are consistent with existing published data on use of IV t-PA in SMs. Until more specific diagnostics are available, suspected SM should not be a reason to withhold t-PA treatment.