Clinical Profile of Stroke Chameleons Receiving Intravenous Thrombolysis: Insights from a Single-Center Experience

Introduction: In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT. Methods: In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023. Results: Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8–26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62–113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98–0.99; p = 0.01). Conclusions: Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging. <p>Introduction: In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT. Methods: In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023. Results: Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8–26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62–113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98–0.99; p = 0.01). Conclusions: Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging. </p>

Project(s)

Genomics of cervical artery dissection: A comprehensive characterization of micro RNA and genetic polymorphisms (GenCAD)

Effect Of Avocado Based Mediterranean Diet On Serum Lipids For Secondary Prevention After Ischemic Stroke

Subjects

cerebral infarction

;

cerebrovascular disease

;

chameleon

;

intravenous thrombolysis

;

ischemic stroke

;

stroke

;

administration, intravenous

;

aged

;

aged, 80 and over

;

diagnosis, differential

;

disability evaluation

;

emergency service, hospital

;

female

;

fibrinolytic agents

;

humans

;

ischemic stroke

;

male

;

middle aged

;

prospective studies

;

risk factors

;

thrombolytic therapy

;

time factors

;

time-to-treatment

;

tissue plasminogen activator

;

treatment outcome

;

fibrinolytic agent

;

fibrinolytic agent

;

tissue plasminogen activator

;

adult

;

aged

;

article

;

cardiovascular risk factor

;

cerebrovascular accident

;

consciousness level

;

controlled study

;

diastolic blood pressure

;

dysarthria

;

emergency ward

;

female

;

hospital admission

;

human

;

informed consent

;

major clinical study

;

male

;

metabolic encephalopathy

;

migraine

;

multivariate analysis

;

national institutes of health stroke scale

;

neuroimaging

;

physician

;

prospective study

;

rankin scale

;

stroke chameleon

;

stroke patient

;

systolic blood pressure

;

wake up stroke

;

adverse event

;

diagnosis

;

differential diagnosis

;

disability assessment

;

drug therapy

;

fibrinolytic therapy

;

hospital emergency service

;

intravenous drug administration

;

ischemic stroke

;

middle aged

;

pathophysiology

;

risk factor

;

therapy

;

time factor

;

time to treatment

;

treatment outcome

;

very elderly