1
|
Wang Y, Qu H, Du W, Wang Y. Stroke mimics: A case report of cervical spondylosis with intravenous thrombolysis. CNS Neurosci Ther 2024; 30:e14434. [PMID: 37649425 PMCID: PMC10945389 DOI: 10.1111/cns.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Yicong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Hui Qu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingChina
| |
Collapse
|
2
|
Multilayer perceptron-based prediction of stroke mimics in prehospital triage. Sci Rep 2022; 12:17994. [PMID: 36289277 PMCID: PMC9606292 DOI: 10.1038/s41598-022-22919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
The identification of stroke mimics (SMs) in patients with stroke could lead to delayed diagnosis and waste of medical resources. Multilayer perceptron (MLP) was proved to be an accurate tool for clinical applications. However, MLP haven't been applied in patients with suspected stroke onset within 24 h. Here, we aimed to develop a MLP model to predict SM in patients. We retrospectively reviewed the data of patients with a prehospital diagnosis of suspected stroke between July 2017 and June 2021. SMs were confirmed during hospitalization. We included demographic information, clinical manifestations, medical history, and systolic and diastolic pressure on admission. First, the cohort was randomly divided into a training set (70%) and an external testing set (30%). Then, the least absolute shrinkage and selection operator (LASSO) method was used in feature selection and an MLP model was trained based on the selected items. Then, we evaluated the performance of the model using the ten-fold cross validation method. Finally, we used the external testing set to compare the MLP model with FABS scoring system (FABS) and TeleStroke Mimic Score (TM-Score) using a receiver operator characteristic (ROC) curve. In total, 402 patients were included. Of these, 82 (20.5%) were classified as SMs. During the ten-fold cross validation, the mean area under the ROC curve (AUC) of 10 training sets and 10 validation sets were 0.92 and 0.87, respectively. In the external testing set, the AUC of the MLP model was significantly higher than that of the FABS (0.855 vs. 0.715, P = 0.038) and TM-Score (0.855 vs. 0.646, P = 0.006). The MLP model had significantly better performance in predicting SMs than FABS and TM-Score.
Collapse
|
3
|
Melaika K, Sveikata L, Vilionskis A, Wiśniewski A, Jurjans K, Klimašauskas A, Jatužis D, Masiliūnas R. Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania. Healthcare (Basel) 2022; 10:healthcare10101958. [PMID: 36292405 PMCID: PMC9601945 DOI: 10.3390/healthcare10101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8−57.6) vs. 28.1% (95% CI 20.1−27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5−90.5) vs. 69.8% (60.0−78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8−77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0−68.0), brain tumors (56.3%, 95% CI 48.5−63.8), and seizures (54.4%, 95% CI 46.7−62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4−11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.
Collapse
Affiliation(s)
| | - Lukas Sveikata
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Aleksandras Vilionskis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Vilnius University, 08661 Vilnius, Lithuania
| | - Adam Wiśniewski
- Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Kristaps Jurjans
- Department of Neurology and Neurosurgery, Riga Stradins University, 1002 Riga, Latvia
- Department of Neurology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Andrius Klimašauskas
- Center of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University, 08661 Vilnius, Lithuania
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania
| | - Rytis Masiliūnas
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-688-62356; Fax: +370-688-62728
| |
Collapse
|
4
|
H. Buck B, Akhtar N, Alrohimi A, Khan K, Shuaib A. Stroke mimics: incidence, aetiology, clinical features and treatment. Ann Med 2021; 53:420-436. [PMID: 33678099 PMCID: PMC7939567 DOI: 10.1080/07853890.2021.1890205] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.
Collapse
Affiliation(s)
- Brian H. Buck
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Naveed Akhtar
- Neurological Institute, Hamad Medical Corporation, Doha, Qatar
| | - Anas Alrohimi
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
- Department of Medicine (Neurology), King Saud University, Riyadh, Saudi Arabia
| | - Khurshid Khan
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| |
Collapse
|
5
|
Chen W, Wang L, Liu Z. MicroRNA-155 influences cell damage in ischemic stroke via TLR4/MYD88 signaling pathway. Bioengineered 2021; 12:2449-2458. [PMID: 34180348 PMCID: PMC8806472 DOI: 10.1080/21655979.2021.1935066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
Cerebral ischemic stroke (CIS) is extremely harmful, and its treatment should be underpinned by understanding its pathogenic mechanism. This study was designed to determine the involvement of miR-155 in CIS development via the TLR4/MyD88 signaling pathway. First, we quantified serum miR-155 in patients with CIS and healthy individuals, and found high expression of miR-155 in such patients and a decrease in it in the patients after therapy (P < 0.05). Serum miR-155 demonstrated a favorable function in predicting the development and prognosis of CIS (P < 0.001). We also conducted a mouse assay, and found that knocking out miR-155 can improve the neurological function of mice and suppress protein TLR4 and MyD88 (all P < 0.05). Finally, we carried out a cell assay, and found enhancement in the activity of SH-SY5Y cells, decrease in their apoptosis, and protein TLR4 and MyD88 in them after suppression of miR-155 (all P < 0.05). Furthermore, we also found complete reverse by TLR4/MyD88 pathway inhibitor on the influence of increasing miR-155 on cells (P > 0.05). Therefore, with an increase in cases with CIS, miR-155 takes a part in the development of cell damage by activating TLR4/MyD88, and it is probably the key to diagnosing and treating CIS.
Collapse
Affiliation(s)
- Wei Chen
- Department of Neurology, Linhai Second People’s Hospital, Taizhou, 317016, Zhejiang, China
| | - Lingtong Wang
- Department of Neurology, Linhai Second People’s Hospital, Taizhou, 317016, Zhejiang, China
| | - Zhaoping Liu
- Department of rehabilitation medicine, Chenzhou first people’s Hospital (the First Affiliated Hospital of Xiangnan University), Chenzhou, 423000, Hunan, PR China
| |
Collapse
|
6
|
Barra M, Faiz KW, Dahl FA, Næss H. Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital. Acta Neurol Scand 2021; 144:695-705. [PMID: 34498731 DOI: 10.1111/ane.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). MATERIALS & METHODS All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. RESULTS SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. CONCLUSIONS SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.
Collapse
Affiliation(s)
- Mathias Barra
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
- Institute for Global Health BCEPSUniversity of Bergen Bergen Norway
| | - Kashif Waqar Faiz
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
- Department of Neurology Akershus University Hospital HF Lørenskog Norway
| | - Fredrik Andreas Dahl
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
| | - Halvor Næss
- Department of Neurology Haukeland University Hospital HF Bergen Norway
- Centre for age‐related medicine Stavanger University Hospital Stavanger Norway
- Institute of clinical medicine University of Bergen Bergen Norway
| |
Collapse
|
7
|
Schäfer SK, Fleischmann R, von Sarnowski B, Bläsing D, Flöel A, Wurm S. Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study. BMJ Open 2021; 11:e049944. [PMID: 34187831 PMCID: PMC8245451 DOI: 10.1136/bmjopen-2021-049944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke. METHODS AND ANALYSIS The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models. ETHICS AND DISSEMINATION The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives. TRIAL REGISTRATION NUMBER NCT04704635.
Collapse
Affiliation(s)
- Sarah K Schäfer
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Dominic Bläsing
- Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Susanne Wurm
- Institute for Community Medicine, Department of Social Medicine and Prevention, University of Greifswald Faculty of Medicine, Greifswald, Germany
| |
Collapse
|
8
|
Poon JT, Tkach A, Havenon AHD, Hoversten K, Johnson J, Hannon PM, Chung LS, Majersik JJ. Telestroke consultation can accurately diagnose ischemic stroke mimics. J Telemed Telecare 2021:1357633X21989558. [PMID: 33535915 DOI: 10.1177/1357633x21989558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telestroke (TS) networks are standard in many areas of the US. Despite TS systems having approximately 33% mimic rates, it is unknown if TS can accurately diagnose patients with acute ischemic stroke (AIS) versus stroke mimics. METHODS We performed a retrospective review of consecutive TS consults to 27 TS sites in six states during 2018. Clinical information and diagnosis were extracted from discharge records and compared to those from the TS consult. Discharge diagnoses were verified and coded into 12 categories. Cases without a clear discharge diagnosis and intracerebral haemorrhage were excluded. We report agreement and a Cohen's kappa between TS and discharge diagnoses for the category of AIS/transient ischemic attack (TIA) versus stroke mimic. RESULTS We included 404 cases in the analysis (mean age 66 years; 54% women). Of these, 225 had a TS diagnosis of AIS/TIA; 102 (45%) received intravenous tissue plasminogen activator. Our study demonstrated a high diagnostic agreement for AIS/TIA (88%) with a kappa of 0.75 for stroke and mimics. Of the 179 patients diagnosed with a stroke mimic on TS, 27 (15%) were diagnosed with AIS/TA by discharge. TS mimic diagnosis had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 90%; TS diagnosis of stroke/TIA had PPV 90%, NPV 85%. DISCUSSION We found excellent correlation between TS and discharge diagnoses for patients with both stroke and stroke mimics. This suggests that TS systems can accurately assess a wider variety of patients with acute neurologic syndromes other than AIS.
Collapse
Affiliation(s)
- Jason T Poon
- Department of Neurology, University of Utah, USA
| | | | - Adam H de Havenon
- Department of Neurology, University of Utah, USA.,Stroke Center, University of Utah, USA
| | - Knut Hoversten
- Department of Neurology, University of Utah, USA.,Stroke Center, University of Utah, USA
| | | | - Peter M Hannon
- Department of Neurology, University of Utah, USA.,Stroke Center, University of Utah, USA
| | - Lee S Chung
- Department of Neurology, University of Utah, USA.,Stroke Center, University of Utah, USA
| | - Jennifer J Majersik
- Department of Neurology, University of Utah, USA.,Stroke Center, University of Utah, USA
| |
Collapse
|
9
|
Akhtar N, Bhutta Z, Kamran S, Babu B, Jose N, Joseph S, Morgan D, Francis R, Own A, Shuaib A. Stroke Mimics: A five-year follow-up study from the Qatar Stroke Database. J Stroke Cerebrovasc Dis 2020; 29:105110. [PMID: 32912536 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Mimics comprise a third of patients presenting with an acute stroke. There is limited information on their natural history. METHODS We evaluate long term major cardiovascular events (MACE) in stroke mimics in a prospective database from Qatar. RESULTS Between Feb 2014 and Jan 2019, 481 patients (male: 238; female: 243) mean age 57.5 years (±18.0), with 399 (83%) medical mimics and 82 (17%) functional mimics were evaluated. Imaging revealed previous old stroke in 26.6% and small vessel disease in 5%. MACE occurred in 57 (11.9%) and there were 31 deaths (6.4%) with majority of deaths (5.6%) from cardiovascular causes. MACE was significantly higher in patients with previous stroke, p < 0.0001), coronary artery disease, p = 0.002), diabetic, p = 0.01), and hypertensive on admission, p < 0.0001. MACE were also significantly higher in patients where imaging showed a previous stroke, p = 0.006). CONCLUSION The occurrence of MACE during follow-up suggests that patients with existing vascular disease require aggressive management of vascular risk factors.
Collapse
Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Zain Bhutta
- Department of Accident and Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Namitha Jose
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Reny Francis
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ahmed Own
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Ashfaq Shuaib
- Department of Medicine (Stroke Program), University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|