| Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. | |
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MedLine Citation:
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PMID: 20335564 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients with acute neurologic symptoms may have other causes simulating ischemic stroke, called stroke mimics (SM), but they may also have averted strokes that do not appear as infarcts on neuroimaging, which we call neuroimaging-negative cerebral ischemia (NNCI). We determined the safety and outcome of IV thrombolysis within 3 hours of symptom onset in patients with SM and NNCI. METHODS: Patients treated with IV tissue plasminogen activator (tPA) within 3 hours of symptom onset were identified from our stroke registry from June 2004 to October 2008. We collected admission NIH Stroke Scale (NIHSS) score, modified Rankin score (mRS), length of stay (LOS), symptomatic intracerebral hemorrhage (sICH), and discharge diagnosis. RESULTS: Among 512 treated patients, 21% were found not to have an infarct on follow-up imaging. In the SM group (14%), average age was 55 years, median admission NIHSS was 7, median discharge NIHSS was 0, median LOS was 3 days, and there were no instances of sICH. The most common etiologies were seizure, complicated migraine, and conversion disorder. In the NNCI group (7%), average age was 61 years, median admission NIHSS was 7, median discharge NIHSS was 0, median LOS was 3 days, and there were no instances of sICH. Nearly all SM (87%) and NNCI (91%) patients were functionally independent on discharge (mRS 0-1). CONCLUSIONS: Our data support the safety of administering IV tissue plasminogen activator to patients with suspected acute cerebral ischemia within 3 hours of symptom onset, even when the diagnosis ultimately is found not to be stroke or imaging does not show an infarct. |
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Authors:
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O Y Chernyshev; S Martin-Schild; K C Albright; A Barreto; V Misra; I Acosta; J C Grotta; S I Savitz |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-03-24 |
Journal Detail:
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Title: Neurology Volume: 74 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-27 Completed Date: 2010-05-10 Revised Date: 2011-07-28 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 1340-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, University of Texas Medical School at Houston, Houston, TX 77030, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Analysis of Variance Brain Ischemia / diagnosis*, drug therapy* Chi-Square Distribution Diagnosis, Differential Drug Toxicity Female Fibrinolytic Agents / adverse effects, therapeutic use Humans Length of Stay Male Middle Aged Registries Retrospective Studies Risk Factors Stroke / diagnosis*, drug therapy* Tissue Plasminogen Activator / adverse effects*, therapeutic use Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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P01 NS046588-02/NS/NINDS NIH HHS; P50 NS044227/NS/NINDS NIH HHS; R01 NS052971/NS/NINDS NIH HHS; R21 HD060978/HD/NICHD NIH HHS; R21NS064316/NS/NINDS NIH HHS; T32-NS0074212-11/NS/NINDS NIH HHS; T32NS04712/NS/NINDS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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J Neurol. 2010 Jun;257(6):1049-51
[PMID:
20490820
]
Neurology. 2010 Apr 27;74(17):1336-7 [PMID: 20335563 ] Neurology. 2010 Nov 16;75(20):1853-4; author reply 1854 [PMID: 21121100 ] Neurology. 2010 Nov 16;75(20):1853; author reply 1854 [PMID: 21079190 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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