Department of Neurology, University of Texas Medical School at Houston, Houston, TX 77030, USA.
Neurology. 2010 Apr 27;74(17):1340-5. doi: 10.1212/WNL.0b013e3181dad5a6. Epub 2010 Mar 24.
Patients with acute neurologic symptoms may have other causes simulating ischemic stroke, called stroke mimics (SM), but they may also have averted strokes that do not appear as infarcts on neuroimaging, which we call neuroimaging-negative cerebral ischemia (NNCI). We determined the safety and outcome of IV thrombolysis within 3 hours of symptom onset in patients with SM and NNCI.
Patients treated with IV tissue plasminogen activator (tPA) within 3 hours of symptom onset were identified from our stroke registry from June 2004 to October 2008. We collected admission NIH Stroke Scale (NIHSS) score, modified Rankin score (mRS), length of stay (LOS), symptomatic intracerebral hemorrhage (sICH), and discharge diagnosis.
Among 512 treated patients, 21% were found not to have an infarct on follow-up imaging. In the SM group (14%), average age was 55 years, median admission NIHSS was 7, median discharge NIHSS was 0, median LOS was 3 days, and there were no instances of sICH. The most common etiologies were seizure, complicated migraine, and conversion disorder. In the NNCI group (7%), average age was 61 years, median admission NIHSS was 7, median discharge NIHSS was 0, median LOS was 3 days, and there were no instances of sICH. Nearly all SM (87%) and NNCI (91%) patients were functionally independent on discharge (mRS 0-1).
Our data support the safety of administering IV tissue plasminogen activator to patients with suspected acute cerebral ischemia within 3 hours of symptom onset, even when the diagnosis ultimately is found not to be stroke or imaging does not show an infarct.
急性神经症状患者可能有其他模拟缺血性脑卒中的病因，称为脑卒中模拟（SM），但他们也可能避免了影像学上没有梗死的脑卒中，我们称之为神经影像学阴性脑缺血（NNCI）。我们确定了在症状发作后 3 小时内对 SM 和 NNCI 患者进行 IV 溶栓的安全性和结果。
从我们 2004 年 6 月至 2008 年 10 月的脑卒中登记处中确定了在症状发作后 3 小时内接受 IV 组织型纤溶酶原激活剂（tPA）治疗的患者。我们收集了入院时 NIH 卒中量表（NIHSS）评分、改良 Rankin 量表（mRS）、住院时间（LOS）、症状性颅内出血（sICH）和出院诊断。
在 512 名接受治疗的患者中，21%的患者在随访影像学上未发现梗死。在 SM 组（14%）中，平均年龄为 55 岁，入院 NIHSS 中位数为 7，出院 NIHSS 中位数为 0，LOS 中位数为 3 天，无 sICH 发生。最常见的病因是癫痫发作、复杂偏头痛和转换障碍。在 NNCI 组（7%）中，平均年龄为 61 岁，入院 NIHSS 中位数为 7，出院 NIHSS 中位数为 0，LOS 中位数为 3 天，无 sICH 发生。几乎所有的 SM（87%）和 NNCI（91%）患者出院时功能独立（mRS 0-1）。
我们的数据支持在症状发作后 3 小时内对疑似急性脑缺血患者使用 IV 组织型纤溶酶原激活剂的安全性，即使最终诊断不是脑卒中或影像学上没有梗死。
