Willenberg Rafer, Leung Bo, Song Shlee, Dumitrascu Oana M, Schlick Konrad, Lyden Patrick
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA.
Neurol Clin Pract. 2021 Feb;11(1):64-68. doi: 10.1212/CPJ.0000000000000828.
Munchausen syndrome by tissue plasminogen activator (tPA) is a phenomenon we describe as patients exhibiting factitious symptoms to assume the role of the sick patient, desiring and received tPA, with no alternative diagnosis or secondary gain to better account for their presentation. To illustrate this phenomenon and its magnitude, we present a series of cases of Munchausen syndrome by tPA, prevalence in our stroke center, and highlight one illustrative case.
Of 335 cases with tPA administration over 29 months, 10 were confirmed as Munchausen syndrome by tPA, reflecting a 3.0% prevalence in our stroke center.
Munchausen syndrome by tPA is an underappreciated phenomenon encountered in evaluating patients with acute stroke symptoms. Administering tPA in Munchausen syndrome poses an ethical dilemma because standard of care favors rapid tPA administration, but administration can cause harm, burdens the healthcare system, and does not treat the patient's Munchausen syndrome.
组织型纤溶酶原激活剂（tPA）所致的孟乔森综合征是一种我们所描述的现象，即患者表现出虚构症状以扮演患病角色，渴望并接受tPA治疗，且没有其他可替代诊断或继发获益能更好地解释其临床表现。为阐述这一现象及其程度，我们呈现了一系列tPA所致孟乔森综合征病例、在我们卒中中心的患病率，并重点介绍一个典型病例。
在29个月内接受tPA治疗的335例患者中，有10例被确诊为tPA所致的孟乔森综合征，这反映出在我们卒中中心的患病率为3.0%。
tPA所致的孟乔森综合征是在评估急性卒中症状患者时未得到充分认识的一种现象。在孟乔森综合征患者中使用tPA会引发伦理困境，因为医疗标准倾向于快速给予tPA，但使用tPA可能会造成伤害、给医疗系统带来负担，且无法治疗患者的孟乔森综合征。
