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Macias-Gómez A, Suárez-Pérez A, Rodríguez-Campello A, Giralt-Steinhauer E, Moreira A, Guisado-Alonso D, Capellades J, Fernández-Pérez I, Jiménez-Conde J, Rey L, Jiménez-Balado J, Roquer J, Ois Á, Cuadrado-Godia E. Factors associated with migraine aura mimicking stroke in code stroke. Neurol Sci 2023; 44:2113-2120. [PMID: 36749530 DOI: 10.1007/s10072-023-06641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Migraine with aura (MA) is a frequent stroke simulator that can lead to erroneous diagnosis and subsequent unnecessary acute or secondary prevention treatments. We analyzed clinical and laboratory data of migraine with aura and ischemic stroke patients to detect differences that could help in the diagnosis. METHODS Retrospective analysis of a consecutive register of code strokes between January 2005 and June 2020. Diagnosis of ischemic stroke or MA was collected. Multivariable logistic regression analyses were performed to test associations between clinical and blood data with ischemic stroke. RESULTS Of 3140 code strokes, 2424 (77.2%) were ischemic strokes and 34 (1.1%) were MA. Migraine cases were younger, more frequently females and with lower prevalence of vascular risk factors. Initial NIHSS was lower in MA cases, but no differences were seen in fibrinolysis rate (30%). Blood test showed lower levels of glucose, D-dimer, and fibrinogen in MA cases. Multivariable model showed and independent association for ischemic stroke with age [OR, (95%CI): 1.09, (1.07-1.12, p < 0.001], male sex [OR, (95%CI): 4.47, (3.80-5.13), p < 0.001], initial NIHSS [OR, (95%CI): 1.21, (1.07-1.34), p < 0.01], and fibrinogen levels [OR, (95%CI): 1.01, (1.00-1.01), p < 0.05]. A model including sex male OR: 3.55 [2.882; 4.598], p < 0.001, and cutoff points (age > 65, OR: 7.953 [7.256; 8.649], p < 0.001, NIHSS > 6, OR: 3.740 [2.882; 4.598], p < 0.01, and fibrinogen > 400 mg/dL, OR: 2.988 [2.290; 3.686], p < 0.01) showed a good global discrimination capability AUC = 0.89 (95%CI: 0.88-0.94). CONCLUSIONS In code stroke, a model including age, sex, NIHSS, and fibrinogen showed a good discrimination capability to differentiate between MA and Ischemic stroke. Whether these variables can be implemented in a diagnostic rule should be tested in future studies.
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Affiliation(s)
- Adrià Macias-Gómez
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Antoni Suárez-Pérez
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Ana Rodríguez-Campello
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain. .,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.
| | - Antía Moreira
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Jaume Capellades
- Neuroradiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Isabel Fernández-Pérez
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Jordi Jiménez-Conde
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Lucía Rey
- Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Joan Jiménez-Balado
- Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Jaume Roquer
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Ángel Ois
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.,Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
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Gonzalez-Martinez A, Trillo S, Benavides-Bernaldo de Quirós C, Casado-Fernández L, De Toledo M, Barbosa-Del Olmo A, Vega Piris L, Ramos C, Manzanares-Soler R, Ximénez-Carrillo Á, Vivancos J. Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code. Eur J Neurol 2021; 28:1939-1948. [PMID: 33609295 DOI: 10.1111/ene.14783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Stroke mimics (SMs) account for a significant number of patients attended as stroke code (SC) with an increasing number over the years. Recent studies show perfusion computed tomography (PCT) alterations in some SMs, especially in seizures. The objective of our study was to evaluate the clinical characteristics and PCT alterations in SMs attended as SC in order to identify potential predictors of PCT alterations in SMs. METHODS A retrospective study was performed including all SC activations undergoing a multimodal CT study including non-enhanced computed tomography (CT), CT angiography and PCT, as part of our SC protocol, over 39 months. Patients with a final diagnosis of SM after complete diagnosis work-up were therefore selected. Clinical variables, diagnosis, PCT alteration patterns and type of map affected (Tmax or time to peak, cerebral blood flow and cerebral blood volume) were registered. RESULTS Stroke mimics represent up to 16% (284/1761) of SCs with a complete multimodal study according to our series. Amongst SMs, 26% (74/284) showed PCT alterations. PCT abnormalities are more prevalent in seizures and status epilepticus and the main pattern is alteration of the time to peak map, of unilateral hemispheric distribution or of non-vascular territory. In our series, the independent predictors of alteration in PCT in SMs are aphasia, female sex and older age. CONCLUSIONS Perfusion computed tomography alterations can be found amongst almost a third of SMs attended as SC, especially older women presenting with aphasia with a final diagnosis of epileptic seizures and status epilepticus.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - Santiago Trillo
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Laura Casado-Fernández
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - María De Toledo
- Epilepsy Unit, Department of Neurology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Antonio Barbosa-Del Olmo
- Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorena Vega Piris
- Methodological Support Unit, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Ramos
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rafael Manzanares-Soler
- Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - José Vivancos
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
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Matuja SS, Khanbhai K, Mahawish KM, Munseri P. Stroke mimics in patients clinically diagnosed with stroke at a tertiary teaching hospital in Tanzania: a prospective cohort study. BMC Neurol 2020; 20:270. [PMID: 32635888 PMCID: PMC7339381 DOI: 10.1186/s12883-020-01853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Stroke mimics account for up to one-third of acute stroke admissions and are a heterogeneous entity which pose diagnostic challenges. Diagnosing such patients is however crucial to avoid delays in treatment and potentially harmful medication prescription. We aimed at describing the magnitude, clinical characteristics and short-term outcomes of stroke mimics in patients clinically diagnosed with a stroke. METHODS This prospective study enrolled patients admitted with a World Health Organization clinical criteria for stroke at a tertiary hospital in Tanzania. Baseline data was collected and the simplified version of the FABS scale was used to determine its usefulness in predicting stroke mimics. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess for admission stroke severity and outcomes respectively. RESULTS Among 363 patients with suspected stroke on admission, the final diagnosis was stroke mimics in 24 (6.6%) who had a mean age of 65.8 ± 15 years. Patients with stroke mimics were less likely to have cardiovascular risk factors for stroke including premorbid hypertension (7 (29.2%) vs 263 (77.6%), p < 0.001) and increased waist-hip ratio (9 (37.5%) vs 270 (79.6%) p < 0.001) for mimics and true strokes respectively. Clinical findings such as hypertension and the presence of cortical features in neurological examination occurred less in patients with stroke mimics. The simplified FABS score of ≥3 could identify patients with stroke mimics with a sensitivity and specificity of 38 and 80% respectively. The most common causes of mimics were brain tumors 6 (25%), meningoencephalitis 4 (16.7%) and epileptic seizures 3 (12.5%). The majority of patients with stroke mimics had severe disease on admission and the 30-day mortality in these patients was 54.5%. CONCLUSIONS In the present study, the proportion of stroke mimics among patients clinically diagnosed with stroke was 6.6% and brain tumors was a common etiology. Stroke mimics were less likely to have cardiovascular risk factors and cortical signs during evaluation. We recommend further studies that can help develop clinical scales used for predicting stroke mimics in an African population.
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Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P. O Box 1464, Mwanza, Tanzania.
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Karim M Mahawish
- Department of Internal Medicine, Midcentral District Health Board, Palmerston North, New Zealand
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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