Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile

Background: The decision to treat with intravenous (i.v.) rt-PA a patient with acute cerebral ischaemia is based on clinical and imaging criteria recorded in emergency. In such an emergency situation stroke mimics may sometimes be misdiagnosed, and lead to an erroneous prescription of rtPA. The objective of this study was to determine the baseline profile and the outcome in patients with stroke mimics who received i.v. rtPA. Methods: We analysed clinical characteristics, and outcomes in patients diagnosed at discharge as having a stroke mimic who received rtPA in the university hospitals of Lille and Belgrade. Results: Amongst 488 patients, seven (1.4%) were diagnosed at discharge with stroke mimics: four had somatoform disturbances, one had migraine aura, one had Bell palsy, and one had a probable Todd's palsy. Patients with stroke mimics were younger, and had milder deficits. Six were investigated by computed tomographic-scan and the only one who had an emergency magnetic resonance imaging, had no abnormality on diffusion weighted images. Five patients had a modified Rankin scale 0-1 and there was no case of intracranial bleeding. Conclusion: Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.