Different pattern of clinical deficits in stroke mimics treated with intravenous thrombolysis.

BACKGROUND: Guidelines recommend intravenous thrombolysis (IVT) to be applied as early as possible in ischemic stroke (IS), while clinical presentation is often assessed by using the National Institutes of Health Stroke Scale (NIHSS). However, diagnostic workup under time pressure bears the risk of misdiagnosis. Little is known about whether NIHSS could help to differentiate between IS and stroke mimics (SM) in patients being evaluated for IVT.

METHODS: Prospectively collected data of 326 consecutive patients treated with IVT were analyzed. Baseline characteristics and NIHSS subscores were compared between SM and IS.

RESULTS: Among 326 patients, 23 (7%) had a final diagnosis other than IS. Age and vascular risk factors were comparable in both groups. Patients with SM less often had oculomotor disturbance (0 vs. 37%, p < 0.001), dysarthria (9 vs. 51%, p < 0.001), hemineglect (0 vs. 30%, p < 0.01), hemianopia (0 vs. 22%, p < 0.01) and facial palsy (33 vs. 70%, p < 0.01). On the other hand, global aphasia without hemiparesis was more prevalent in SM patients (43 vs. 6%, p < 0.001).

CONCLUSION: Our study suggests that patients with SM undergoing IVT present with a different pattern of clinical deficits than patients with IS.