Ayer Neuroscience Institute, Hartford HealthCare, Hartford Hospital, Hartford, Connecticut; University of Connecticut, Hartford, Connecticut.
Ayer Neuroscience Institute, Hartford HealthCare, Hartford Hospital, Hartford, Connecticut; University of Connecticut, Hartford, Connecticut.
J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104282. doi: 10.1016/j.jstrokecerebrovasdis.2019.06.040. Epub 2019 Aug 8.
Migraine, seizures, and psychiatric disorders are frequently reported as "stroke mimics" in patients with negative diffusion-weighted imaging (DWI) after IV-tPA. We sought to determine predictors of negative DWI in suspected stroke patients treated with IV-tPA.
A retrospective case-control study encompassing all acute stroke patients treated with IV-tPA (at our hospital or "dripped and shipped") from January 2013 to December 2014 was con- ducted. A total of 275 patients were identified with 47 negative DWI cases and 228 positive DWI controls. Variables including demographic factors, stroke characteristics, and clinical comorbidities were analyzed for statistical significance. A multivariate logistic regression was performed (SPSS-24) to identify predictors of negative DWI.
Approximately 17% of patients had negative DWI after IV-tPA. Compared to controls, migraine history independently predicted negative DWI (odds ratio [OR] 5.0 95% confidence interval [CI] 1.03-24.6, P = .046). Increasing age (OR .97 95% CI .94-.99, P = .02) and atrial fibrillation (OR .25 95% CI .08-.77, P = .01) predicted lower probability of negative DWI. Gender, admission NIHSS, treatment location, preadmission modified Rankin scale, diabetes mellitus, hypertension, hyperlipidemia, symptom side, seizure history, and psychiatric history did not predict negative DWI status.
In our study, roughly 1 in 6 patients treated with IV-tPA were later found to be stroke mimics with negative DWI. Despite a high proportion of suspected stroke mimics in our study, only preexisting migraine history independently predicted negative DWI status after IV-tPA treatment in suspected stroke patients.
在接受 IV-tPA 治疗后扩散加权成像（DWI）阴性的疑似中风患者中，常报告偏头痛、癫痫发作和精神障碍为“中风模拟症”。我们旨在确定接受 IV-tPA 治疗的疑似中风患者中 DWI 阴性的预测因素。
对 2013 年 1 月至 2014 年 12 月期间在我院或“输液和转运”接受 IV-tPA 治疗的所有急性中风患者进行回顾性病例对照研究。共确定 275 例患者，其中 47 例 DWI 阴性病例和 228 例 DWI 阳性对照。分析了包括人口统计学因素、中风特征和临床合并症在内的变量，以确定统计学意义。采用多变量逻辑回归（SPSS-24）确定 DWI 阴性的预测因素。
约 17%的患者在接受 IV-tPA 后 DWI 呈阴性。与对照组相比，偏头痛病史独立预测 DWI 阴性（优势比 [OR] 5.0，95%置信区间 [CI] 1.03-24.6，P=0.046）。年龄增加（OR 0.97，95%CI 0.94-0.99，P=0.02）和心房颤动（OR 0.25，95%CI 0.08-0.77，P=0.01）预测 DWI 阴性的可能性较低。性别、入院 NIHSS、治疗地点、入院前改良 Rankin 量表、糖尿病、高血压、高脂血症、症状侧、癫痫发作史和精神病史均不能预测 DWI 阴性状态。
在我们的研究中，接受 IV-tPA 治疗的患者中约有 1/6 被发现为 DWI 阴性的中风模拟症。尽管我们的研究中有相当高比例的疑似中风模拟症，但只有预先存在的偏头痛病史独立预测了疑似中风患者接受 IV-tPA 治疗后的 DWI 阴性状态。
