Introduction: The use of r-tPA to treat stroke patient presenting within 4.5 hours of symptoms onset has rapidly expanded with the advent of telestroke. This expansion may further exacerbate the concerns related to treating patients with alternative diagnoses (stroke mimics).
Hypothesis: Stroke mimics rate is higher in patient treated through telestroke and is associated with a higher rate of hemorrhagic conversion.
Methods: This is a single center cross-sectional analysis of possible stroke patients treated with r-tPA from January 2013 to October 2014 using retrospective panel review of post-tPA negative imaging (MRI and CT) for diagnoses of stroke mimics and provision of alternative diagnoses. The frequency of stroke mimics was compared between patients treated via telestroke and on-site treated patients. Rate of hemorrhagic transformation was compared between stroke mimics and “actual stroke”.
Results: Overall 66 (23.3%) stroke mimics were identified including 53 (27.2%) in the telestroke group and 13 (14.8%) in the In-house group (P= 0.033). There was a total 34 (12.0%) hemorrhagic transformation in the entire cohort with 2 (3.0%) occurring in stroke mimics and 32 (14.7%) in those with an established diagnosis of acute infarct (p = 0.019).
Conclusion: In this single center cohort, the rate of stroke mimics was twice as high in participants treated via telestroke as in on-site treated participants. The rate of hemorrhagic transformation in stroke mimics was lower than in those with stroke.