Tissue-Type Plasminogen Activator for Stroke Mimics

Abstract

In the April issue of Stroke , we have yet another study on the safety of tissue-type plasminogen activator (tPA) for patients with stroke mimics (SM). Zinkstok et al1 conducted a multicenter retrospective analysis of patients with SM treated with tPA at primary and community hospitals. With 100 patients reported in the largest series to date, the authors found, like all the previous cohort studies, a low rate of symptomatic intracerebral hemorrhage and death.2,3 There were no instances of orolingual edema or fatal intracerebral hemorrhages. The incidence of SM in their cohort among all tPA-treated patients was on the lower end of other reports: 2% to 31%.2,4–6 This rate is also much lower than the 7% misdiagnosis rate reported for emergency departments in which tPA was administered without a stroke team evaluation.7 In fact, …