A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate

Published: 1 February 2024
Abstract Views: 519
PDF: 202
HTML: 38
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Merino JG, Luby M, Benson RT, et al. Predictors of acute stroke mimics in 8187 patients referred to a stroke service. J Stroke Cerebrovasc Dis 2013;22:e397-403. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.018
Tsivgoulis G, Zand R, Katsanos AH, et al. Safety of intravenous thrombolysis in stroke mimics. Stroke 2015;46:1281-7. DOI: https://doi.org/10.1161/STROKEAHA.115.009012
Tu TM, Tan GZ, Saffari SE, et al. External validation of stroke mimic prediction scales in the emergency department. BMC Neurol 2020;20:269-78. DOI: https://doi.org/10.1186/s12883-020-01846-6
A Santa Maria Nova l’unico ‘centro diamante’ italiano per pazienti colpiti da ictus, in “Prima Firenze”. Available from https://primafirenze.it/cronaca/santa-maria-nuovaunico-centro-diamante-italiano-ictus/ (accessed on June 3rd, 2021)
Goyal N, Tsivgoulis G, Male S, et al. FABS: an intuitive tool for screening of stroke mimics in the emergency department. Stroke 2016;47:2216-20. DOI: https://doi.org/10.1161/STROKEAHA.116.013842
Qin X, Zhao S, Yin L, et al. Validation of simplified FABS scale to predict stroke mimics in a Chinese population undergoing intravenous thrombolysis. Clin Neurol Neurosurg 2017;161:1-5. DOI: https://doi.org/10.1016/j.clineuro.2017.07.013
Ali SF, Viswanathan A, Singhal AB, et al. The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network. J Am Heart Assoc 2014;3:e000838. DOI: https://doi.org/10.1161/JAHA.114.000838
Khan NI, Chaku S, Goehl C, et al. Novel algorithm to help identify stroke mimics. J Stroke Cerebrovasc Dis 2018;27:703-8. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.067
Pohl M, Hesszenberger D, Kapus K, et al. Ischemic stroke mimics: A comprehensive review. J Clin Neurosci 2021;93:174-82. DOI: https://doi.org/10.1016/j.jocn.2021.09.025
Lee H. Isolated vascular vertigo. SJ Stroke 2014;16:124-30. DOI: https://doi.org/10.5853/jos.2014.16.3.124
Kattah JC, Talkad AV, Wang DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009;40:3504-10. DOI: https://doi.org/10.1161/STROKEAHA.109.551234
Tarnutzer AA, Lee SH, Robinson KA, et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: a meta-analysis. Neurology 2017;88:1468-77. DOI: https://doi.org/10.1212/WNL.0000000000003814
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:E344-E418. DOI: https://doi.org/10.1161/STR.0000000000000211
Barra M, Faiz KW, Dahl FA, et al. Stroke Mimics on the Stroke Unit–Temporal trends 2008-2017 at a large Norwegian university hospital. Acta Neurol Scand 2021;144:695-705. DOI: https://doi.org/10.1111/ane.13527
Cortel-LeBlanc MA, Sharma M, Cortel-LeBlanc A, et al. Predictors of neurologists confirming or overturning emergency physicians’ diagnosis of TIA or stroke. CJEM 2021;23:812-9. DOI: https://doi.org/10.1007/s43678-021-00181-0
Geisler F, Ali SF, Ebinger M, et al. Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients. Int J Stroke 2019;14:400-8. DOI: https://doi.org/10.1177/1747493018806194
Fernandes PM, Whiteley WN, Hart SR, Salman RA-S. Strokes: mimics and chameleons. Pract Neurol 2013; 13:21-8. DOI: https://doi.org/10.1136/practneurol-2012-000465

How to Cite

Moroni, F., Vannucchi, V., Vinci, C., Bianchi, S., Giuello, A., Prosperi Iovi, F., Lanigra, M., Konze, A., & Landini, G. (2024). A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate. Italian Journal of Medicine, 18(1). https://doi.org/10.4081/itjm.2024.1693