Abstract
A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies. Retrospective, cohort, observational, single-center study that reviewed all consecutive files of patients presenting with acute neurological symptoms who underwent CT scan or MRI from July 1, 2016 to July 1, 2017. 736 patient files were reviewed. 385 patients (52.3%) presented with confirmed acute ischemic infarct, 93 (12.6%) had another brain lesion mimicking acute ischemia, and 258 (35.1%) had normal imaging. Acute stroke was more frequent in elderly patients with atrial fibrillation, arterial hypertension, or dysarthria or right motor impairment. Stroke mimic was associated with female patients with low vascular risk factors, low NIHSS, and patients with decreased level of consciousness or symptoms suggestive of posterior circulation. 47.7% of all patients seen at the stroke unit did not have acute stroke lesions. Clinical assessment data have been used to provide indicators of acute stroke and stroke mimic patients, and symptoms corresponding to acute stroke and stroke mimic seem to be similar in the literature. Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI.
Highlights
A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment
Arterial hypertension was present in 52.2% of patients, dyslipidemia in 29.7%, and there was history of stroke, transient ischemic attacks (TIA), myocardial infarction, or angina pectoris in 24.7%
Stroke mimics were present in 47.7% of the patients examined in acute phase of suspected stroke
Summary
A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. Conclusion: Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI. Since the benefit of mechanical thrombectomy and the extension of indication of thrombolysis for patients with therapeutic window larger than 4.5 hours were determined, more patients were accepted in the emergency services to undergo imaging exams[1,2]. Selection has been based on imaging findings associated to clinical evaluation, rather than symptom onset time, to indicate which patients could benefit from IV tPA and endovascular arterial recanalization. Imaging tools are used in order to determine a mismatch area when infarct lesion and neurological impairment do not overlap, at extended time windows, i.e., >4.5 and >6h for intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in large vessel occlusion patients, respectively
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