Introduction

Materials and Methods

Results

Discussion

Conclusions

References

Abstract

Background: Stroke mimic is a medical condition presenting with acute neurological deficit and simulate real stroke. The objective of this study was to evaluate the frequency and the various etiologies of stroke mimics in our center. Methods: We retrospectively reviewed the Thrombolysis Alert registry and we studied the frequency and characteristics of patients with stroke mimic. Results: Among 673 patients who were admitted to the emergency department within 4.5 hours for sudden focal neurological deficit suggestive of acute stroke, 105 patients (15.6 %) had a stroke mimic. The mean age of patients with mimics and brain strokes were 66.3 and 64.8, respectively. The mean Onset-to-door time was 136.82 minutes and the mean door-to-imaging time was 32.63 minutes in stroke mimics. Seizure (28.5%) was the most common diagnosis of stroke mimics followed by conversion disorder (25.7%). Conclusions: Stroke mimic is frequent and heterogeneous entity that can be difficult to identify. Fortunately, most previous studies show no harmful effects when using thrombolysis in a stroke mimic.

Introduction

Brain Stroke is a major cause of mortality and morbidity. In Morocco, the prevalence rate of stroke in all agesis estimated at 292 per 100,000. The management of ischemic stroke has seen major advances with intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). IVT has been the standard treatment for acute ischemic stroke (AIS) patients within 4.5 hours of symptom onset. Thrombolysis with tissue plasminogen activator is the first effective approved therapy for potentially disabling AIS. Recently there is more evidence suggesting that other thrombolytics such as tenecteplase may be even more effective. EVT is another effective therapy; it reduces the risk of death or dependency in patients with large vessel occlusion if applied within 6 hours. The recently published DAWN and DEFUSE 3 trials have shown that EVT is also beneficial 6-24 hours after the onset of symptoms in selected patients with favorable imaging brain. The diagnosis of acute ischemic stroke is usually easy by carrying out physical evaluation and studying images of the brain, however several disorders, manifested by an acute neurological deficit can mimic AIS. Stroke mimic term is applied in a clinical evaluation, describing those nonvascular conditions that simulate stroke, namely those presenting with sudden neurological deficit that resembles a stroke but is not related to a vascular cause. Stroke mimics are a major diagnostic challenge. The aim of this study is to evaluate the relative frequency and the various etiologies of stroke mimics in patients with clinical signs of stroke admitted in our emergency room for “Thrombolysis Alert.”