不同模式的临床缺损在接受静脉溶栓治疗的卒中样发作患者中的表现。

Different pattern of clinical deficits in stroke mimics treated with intravenous thrombolysis.

机构信息

Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.

出版信息

Eur Neurol. 2012;68(6):344-9. doi: 10.1159/000337677. Epub 2012 Oct 23.

DOI:10.1159/000337677

PMID:23095714

Abstract

BACKGROUND

Guidelines recommend intravenous thrombolysis (IVT) to be applied as early as possible in ischemic stroke (IS), while clinical presentation is often assessed by using the National Institutes of Health Stroke Scale (NIHSS). However, diagnostic workup under time pressure bears the risk of misdiagnosis. Little is known about whether NIHSS could help to differentiate between IS and stroke mimics (SM) in patients being evaluated for IVT.

METHODS

Prospectively collected data of 326 consecutive patients treated with IVT were analyzed. Baseline characteristics and NIHSS subscores were compared between SM and IS.

RESULTS

Among 326 patients, 23 (7%) had a final diagnosis other than IS. Age and vascular risk factors were comparable in both groups. Patients with SM less often had oculomotor disturbance (0 vs. 37%, p < 0.001), dysarthria (9 vs. 51%, p < 0.001), hemineglect (0 vs. 30%, p < 0.01), hemianopia (0 vs. 22%, p < 0.01) and facial palsy (33 vs. 70%, p < 0.01). On the other hand, global aphasia without hemiparesis was more prevalent in SM patients (43 vs. 6%, p < 0.001).

CONCLUSION

Our study suggests that patients with SM undergoing IVT present with a different pattern of clinical deficits than patients with IS.

摘要

背景

指南建议在缺血性卒中（IS）时尽早进行静脉溶栓（IVT）治疗，而临床表现在很大程度上是通过美国国立卫生研究院卒中量表（NIHSS）来评估的。然而，在时间紧迫的情况下进行诊断性检查可能会导致误诊。目前尚不清楚 NIHSS 是否有助于在接受 IVT 评估的患者中区分 IS 和卒中模拟症（SM）。

方法

分析了 326 例连续接受 IVT 治疗的患者的前瞻性收集数据。比较了 SM 和 IS 患者的基线特征和 NIHSS 子量表评分。

结果

在 326 例患者中，最终诊断为 IS 以外疾病的有 23 例（7%）。两组患者的年龄和血管危险因素相似。SM 患者较少出现眼球运动障碍（0%比 37%，p<0.001）、构音障碍（9%比 51%，p<0.001）、偏盲（0%比 22%，p<0.01）、偏身忽视（0%比 30%，p<0.01）和面瘫（33%比 70%，p<0.01）。另一方面，SM 患者更常见无偏瘫的完全性失语（43%比 6%，p<0.001）。