Thrombolysis to stroke mimics in telestroke.

ABSTRACT

Stroke mimics are patients diagnosed initially with stroke who finally receive a different diagnosis, such as seizure, conversion disorder or encephelopathy. We compared the number of stroke mimics receiving thrombolytic therapy via a telestroke network and via a conventional primary stroke centre. We reviewed the data on all patients who received intravenous t-PA through the ARSAVES statewide telestroke network or at the University of Arkansas for Medical Sciences (UAMS) stroke centre between November 2008 and January 2012. During the study period there were 252 patients (46 UAMS, 206 ARSAVES). Of the 206 telestroke patients, 141 patients (68%) were transferred to the UAMS and were examined there by a vascular neurologist where a diagnosis of stroke or stroke mimic was made; 65 patients (32%) stayed at the peripheral site and were excluded from the present study. Of the 189 study patients, 3-month outcome data were available on 166 (89%), 43 from UAMS (94%) and 123 from ARSAVES (87%). The mean door to needle time was significantly shorter at the UAMS (72 min vs. 91 min, P = 0.001). However, the percentage of good outcomes was similar in both groups (70% vs. 58%, P = 0.21) and both groups had similar total time from symptom onset to treatment (154 min vs. 156 min, P = 0.81) and similar baseline characteristics. The percentage of stroke mimics was similar in the two groups UAMS 4.3% and ARSAVES 7.8% (P = 0.53). Although making a diagnosis of stroke mimic may be challenging on face-to-face encounter, our study shows that this challenge does not increase if telemedicine is used instead. Larger prospective studies are now required to confirm the findings of our study.