Introduction: Several non-vascular conditions may mimic the sudden neurological deficits of stroke (stroke mimics, SM). In Stroke Code, time to treatment is crucial, but the efforts to increase the benefits of iv-tPA may lead to inadvertent treatment of SM. We aim to determine the relationship between door-to-needle (DTN) time and SM treatment.
Methods: Retrospective analysis of all acute stroke patients treated with iv-tPA included in an institutional prospective database. SM were identified during follow-up and their clinical characteristics compared with the confirmed stroke patients in the same time-period.
Results: During a 3-year period, 332 thrombolysed patients were included. Twenty-two were SM (6.6%, 95%CI:4.0%-9.3%), with median age of 58 years (range 35-87), 54.5% were men, median NIHSS=10 (range 3-30). Sudden (81.8%) neurological deficits were motor in 11 patients (52.2%), altered speech in 10 (47.6%) and sensitive in 7 (33.3%). Baseline clinical characteristics (including age, sex, vascular risk factors and initial NIHSS) were similar between stroke and SM groups. Multimodal imaging was used for treatment decision in 95.5% of SM (CT-perfusion 10 patients, CT-angiography 9, MRI 1 and only 1 patient received just non-contrast CT) vs 74.1% of confirmed strokes (p=0.014). Four SM patients presented with neuroimaging abnormalities. DTN of SM was similar to those of strokes (35.5 VS. 40minutes, p=0.6). Despite a progressive decrease in median DTN time (year 1: 47min vs year 3: 36min; p=0.02) the rate of SM treated with tPA did not increase (year 1: 5.4% vs 9% in year 3; p=0.1). No intracranial haemorrhage or other complications were recorded in any SM patient. At discharge, 86.4% of SM presented a modified Rankin Scale 0-1. The most frequent final diagnosis were: migraine (31.8%), functional symptoms (27.3%) and seizures (27.3%).
Conclusions: Despite multimodal neuroimaging, stat differentiation between SM and stroke is still difficult. Reduction of DTN times may not necessarily increase the number of SM thrombolysed. Nevertheless, iv-tPA revealed to be safe in SM and should not be delayed in case of doubt.