Kowalska Magdalena M, Michałowska Małgorzata M, Leńska-Mieciek Marta M
Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Orłowski Hospital, Warsaw, Poland.
Postep Psychiatr Neurol. 2025 Mar;34(1):33-43. doi: 10.5114/ppn.2025.149942. Epub 2025 Apr 30.
Time pressure in the treatment of acute ischemic stroke patients generates difficult decisions for neurologists, sometimes resulting in stroke mimic patients receiving intravenous thrombolytic therapy. Proper diagnosis and appropriate treatment for these patients are crucial, yet incredibly challenging in cases of functional stroke mimics (FSM).
Functional neurological disorders, including FSM, are increasingly diagnosed. However, their pathophysiology and underlying mechanisms are poorly understood, even though the diagnostic criteria for diagnosing FSM exist, and various clinical indicators support them. Functional neurological symptoms often result in serious disability for patients but the effective treatment is unknown. Neurologists need to examine the symptoms and the key clinical findings to distinguish between FSM and stroke. The intravenous thrombolytic therapy appears safe for FSM, but the potential harm of thrombolysis should be a concern. FSMdiagnosed patients require long-term treatment, starting with open and clear communication about their condition and followed by psychoeducation and physiotherapy.
FSM should be diagnosed using the diagnostic criteria. Electronic health information exchange among healthcare providers is necessary to avoid unnecessary thrombolytic treatments in this group of patients.
急性缺血性中风患者的治疗时间紧迫，这给神经科医生带来了艰难的决策，有时会导致疑似中风的患者接受静脉溶栓治疗。对这些患者进行正确诊断和适当治疗至关重要，但在功能性中风模拟（FSM）病例中极具挑战性。
包括FSM在内的功能性神经障碍的诊断越来越多。然而，尽管存在诊断FSM的标准且有各种临床指标支持，但对其病理生理学和潜在机制的了解却很少。功能性神经症状常常导致患者严重残疾，但有效的治疗方法尚不清楚。神经科医生需要检查症状和关键临床发现，以区分FSM和中风。静脉溶栓治疗对FSM似乎是安全的，但溶栓的潜在危害应引起关注。被诊断为FSM的患者需要长期治疗，首先要就其病情进行开放和清晰的沟通，然后进行心理教育和物理治疗。
应使用诊断标准来诊断FSM。医疗服务提供者之间进行电子健康信息交换对于避免对这组患者进行不必要的溶栓治疗是必要的。
