Olindo Stephane, Chardonnet Martin, Renou Pauline, Coignion Cyrielle, Debruxelles Sabrina, Poli Mathilde, Sagnier Sharmila, Rouanet François, Sibon Igor
Department of Neurology, CHU de Bordeaux, Bordeaux, France.
Department of Neurology, CHU de Bordeaux, Bordeaux, France.
J Stroke Cerebrovasc Dis. 2018 Feb;27(2):454-459. doi: 10.1016/j.jstrokecerebrovasdis.2017.09.024. Epub 2017 Nov 8.
Multimodal computed tomography imaging (MCTI) is increasingly used for rapid assessment of acute stroke. We investigated characteristics and final diagnoses of patients treated with recombinant tissue plasminogen activator (rt-PA) while admission imaging was unremarkable.
From our prospectively collected stroke database (2013-2016), we identified consecutive patients treated with rt-PA on the basis of an unremarkable brain MCTI and assessed with a 24-hour follow-up brain magnetic resonance imaging (MRI). Demographic data, medical history, score on the 15-item National Institute of Health Stroke Scale, and final diagnosis were considered. Absence of MRI infarction and alternate diagnosis defined stroke mimics (SMs). Univariable and multivariable logistic regression analyses identified factors predictive of SMs.
Sixty-eight (47.9%) SMs, 63 (44.4%) strokes, and 11 (7.7%) aborted strokes were found. SMs had more often aphasia (P = .003) and hemianopia (P = .0008), whereas upper limb weakness (ULW) (P = .03) and limb ataxia (P = .002) were more prevalent in strokes. Headache (adjusted odds ratio [Adj. OR], 3.89 [95% confidence interval {CI} 1.44-10.47]), relevant history of epilepsy, migraine, dementia or depression (Adj. OR 3.66 [95% CI 1.31-10.18]), unilateral sensory loss (Adj. OR 2.60 [95% CI 1.05-6.45]), and hemianopia (Adj. OR 4.94 [95% CI 1.46-16.77]) were independent predictors of SMs whereas ULW (Adj. OR 3.16 [95% CI 1.28-7.82]) and ataxia (Adj. OR 3.81 [95% CI 1.43-10.13]) predicted stroke. Sensitivity of hemianopia or aphasia for SMs was 52.9%, with specificity of 84.1%, positive predictive value of 78.3%, and negative predictive value of 62.4%.
Hemianopia and/or aphasia with normal MCTI suggest SMs. Diffusion-weighted MRI might be discussed before rt-PA administration in patients with such a clinical pattern.
多模态计算机断层扫描成像（MCTI）越来越多地用于急性卒中的快速评估。我们调查了入院时成像无异常但接受重组组织型纤溶酶原激活剂（rt-PA）治疗的患者的特征和最终诊断结果。
从我们前瞻性收集的卒中数据库（2013 - 2016年）中，我们确定了基于脑MCTI无异常而接受rt-PA治疗并通过24小时随访脑磁共振成像（MRI）进行评估的连续患者。考虑了人口统计学数据、病史、15项美国国立卫生研究院卒中量表评分和最终诊断。MRI无梗死且有其他诊断定义为卒中模拟（SMs）。单变量和多变量逻辑回归分析确定了预测SMs的因素。
发现68例（47.9%）SMs、63例（44.4%）卒中以及11例（7.7%）中止的卒中。SMs更常出现失语（P = 0.003）和偏盲（P = 0.0008），而上肢无力（ULW）（P = 0.03）和肢体共济失调（P = 0.002）在卒中中更常见。头痛（调整优势比[Adj. OR]，3.89[95%置信区间{CI}1.44 - 10.47]）、癫痫、偏头痛、痴呆或抑郁的相关病史（Adj. OR 3.66[95% CI 1.31 - 10.18]）、单侧感觉丧失（Adj. OR 2.60[95% CI 1.05 - 6.45]）和偏盲（Adj. OR 4.94[95% CI 1.46 - 16.77]）是SMs的独立预测因素，而ULW（Adj. OR 3.16[95% CI 1.28 - 7.82]）和共济失调（Adj. OR 3.81[95% CI 1.43 - 10.13]）预测卒中。偏盲或失语对SMs的敏感性为52.9%，特异性为84.1%，阳性预测值为78.3%，阴性预测值为62.4%。
MCTI正常的偏盲和/或失语提示SMs。对于有这种临床模式的患者，在给予rt-PA之前可能需要讨论弥散加权MRI检查。
