Caruso Paola, Radin Yvonne, Mancinelli Laura, Quagliotto Magda, Lombardo Tiziana, Pavan Stefania, Catalan Mauro, Clarici Andrea, Bulfon Matteo, Benussi Alberto, Manganotti Paolo
Department of Medical, Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.
Department of Pediatrics, Neurology Clinic, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
Front Neurol. 2024 Sep 4;15:1461320. doi: 10.3389/fneur.2024.1461320. eCollection 2024.
FNDs mimicking a stroke represent a growing challenge in the emergency department (ED). A comprehensive diagnostic approach involving clinical evaluation and neuroimaging is essential to differentiate stroke from mimics. The safety profile of thrombolysis justifies its use where FNDs cannot be ruled out. This approach highlights the need for more precise diagnostic tools and protocols to improve patient care and reduce unnecessary treatments. Distinguishing FNDs from actual cerebrovascular events is critical yet difficult, particularly under time constraints. Given the urgency and potential severity of strokes, intravenous thrombolysis is frequently administered even when FNDs cannot be definitively excluded.
This retrospective study analyzed data of participants admitted to the Trieste University Hospital Stroke Unit between January 2018 and December 2022, focusing on those presenting with sudden-onset focal neurological deficits mimicking a stroke, with some presenting within the reperfusion treatment window (<4.5 h from symptoms onset). We obtained detailed clinical evaluations and neuroimaging, and administered thrombolytic therapy in selected cases.
We included 84 participants presenting with stroke mimics (average age of 45 yo) predominantly female (65.5%). Most common presentations: hemiparesis or hemisensory loss (75%), speech disorder (10.7%), vertigo/gait disorders (4.8%). History of psychiatric disorders was found in 32.1% of cases, and 48.8% had prior neurological disease or stroke risk factors. Advanced neuroimaging was performed in 43 cases yielding normal or non-specific results. Thrombolysis was safely administered in 31%. Patients mostly recovered within the first 24 h from admission (44.7%). We compared this FND's sample with 291 patients with mild ischemic stroke (NIHSS ≤7).
在急诊科，模仿中风的功能性神经疾病（FNDs）构成了日益严峻的挑战。采用包括临床评估和神经影像学检查在内的综合诊断方法对于区分中风与模仿者至关重要。溶栓治疗的安全性证明了在无法排除FNDs的情况下使用它是合理的。这种方法凸显了需要更精确的诊断工具和方案，以改善患者护理并减少不必要的治疗。将FNDs与实际脑血管事件区分开来至关重要但却困难，尤其是在时间限制下。鉴于中风的紧迫性和潜在严重性，即使不能明确排除FNDs，也经常进行静脉溶栓治疗。
这项回顾性研究分析了2018年1月至2022年12月期间入住的里雅斯特大学医院卒中单元的参与者的数据，重点关注那些表现出模仿中风的突发局灶性神经功能缺损的患者，其中一些患者在再灌注治疗窗口内（症状发作后<4.5小时）就诊。我们获得了详细的临床评估和神经影像学检查结果，并在选定的病例中进行了溶栓治疗。
我们纳入了84名表现出类似中风症状的参与者（平均年龄45岁），其中女性占大多数（65.5%）。最常见的表现：偏瘫或半身感觉丧失（75%）、言语障碍（10.7%）、眩晕/步态障碍（4.8%）。32.1%的病例有精神疾病史，48.8%有既往神经疾病或中风危险因素。对43例患者进行了高级神经影像学检查，结果正常或不具有特异性。31%的患者安全接受了溶栓治疗。大多数患者在入院后的头24小时内康复（44.7%）。我们将这个FNDs样本与291名轻度缺血性中风患者（美国国立卫生研究院卒中量表[NIHSS]≤7）进行了比较。
