Kim Min Chan, Kim Seok Won
Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
Korean J Neurotrauma. 2018 Apr;14(1):20-23. doi: 10.13004/kjnt.2018.14.1.20. Epub 2018 Apr 30.
Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke.
We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis. Subsequently, emergent computed tomography scan showed no intracranial hemorrhage. Clinical findings including neurological deficits, clinical course, and related complications were detected and analyzed.
Acute hemiparesis was observed in the following conditions: spontaneous spinal epidural hematoma, Brown-Séquard syndrome caused by cervical disc herniation, cervical epidural abscess, hypoglycemia in the presence of an old stroke, and seizure or convulsion disorder. Although acute hemiparesis was regarded as a contraindication, inappropriate TPA administration did not aggravate the neurological condition in any of the patients who required surgery.
Upon presentation of acute hemiparesis, various conditions mimicking cerebral stroke should be considered to avoid misdiagnosis. We suggest that physicians should exercise caution when prescribing thrombolytic agents.
急性偏瘫通常是急性缺血性卒中的早期表现，不过它也可能出现在各种疾病中。本研究旨在调查急性偏瘫患者在被误诊为急性缺血性卒中后溶栓药物的不当使用情况。
我们分析了2013年5月至2017年1月期间在急诊室最初被误诊为脑卒中的9例患者的临床和影像学资料。由于存在急性偏瘫，所有患者均接受了组织纤溶酶原激活剂（TPA）治疗。随后，急诊计算机断层扫描显示无颅内出血。检测并分析了包括神经功能缺损、临床病程及相关并发症在内的临床发现。
在以下情况下观察到急性偏瘫：自发性脊髓硬膜外血肿、颈椎间盘突出症所致的布朗 - 塞卡尔综合征、颈椎硬膜外脓肿、存在陈旧性卒中时的低血糖以及癫痫或惊厥障碍。尽管急性偏瘫被视为禁忌证，但在任何需要手术的患者中，不适当的TPA给药均未加重神经状况。
出现急性偏瘫时，应考虑各种类似脑卒中的情况以避免误诊。我们建议医生在开具溶栓药物时应谨慎。
