Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST).

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968555 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2377 (Electronic) Linking ISSN: 14712377 NLM ISO Abbreviation: BMC Neurol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Ischemic Attack, Transient*/drug therapy ; Ischemic Stroke*/drug therapy ; Stroke*/diagnosis ; Stroke*/drug therapy ; Brain Ischemia*/diagnosis ; Brain Ischemia*/drug therapy ; Migraine Disorders*/drug therapy; Humans ; Female ; Aged ; Middle Aged ; Male ; Tenecteplase/therapeutic use ; Tissue Plasminogen Activator/adverse effects ; Fibrinolytic Agents/adverse effects ; Norway/epidemiology ; Treatment Outcome
    • Abstract:
      Background: Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group.
      Methods: Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (< 60 years) and old (≥ 60 years). Logistic regression analyses were performed with mimics vs. stroke as dependent variable to identify predictors of mimics.
      Results: Of the 1091 patients included in the trial, 211 patients (19.3%) were under the age of 60 years. Out of the 1091 patients, 434 (39.8%) were female, median age 77 years (18-99 years), and median NIHSS was 4. Sixty-nine patients (32.7%) out of the 211 patients under the age of 60 were diagnosed as mimic. Mimics were significantly more frequent among the young (OR = 3.3, 32.7% vs. 12.8%, p = < 0.001). The most frequent mimics diagnoses among patients under 60 years of age were migraine (11.8%), no definite diagnosis (11.4%) and peripheral vertigo (3.3%). Mimics were independently associated with age < 50 years (OR = 4.97, p = < 0.001), not currently working/studying (OR = 3.38, p = 0.002) and not having aphasia on admission (OR = 2.95, p = 0.025). None of the mimics under the age of 60 years had symptomatic or asymptomatic intracerebral hemorrhage as a complication to thrombolysis.
      Conclusion: We found significantly more mimics in the young, of which migraine was the most predominant diagnosis. Thrombolysis with alteplase or tenecteplase did not cause ICH in any mimics under 60 years.
      (© 2023. The Author(s).)
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    • Contributed Indexing:
      Keywords: Acute ischemic stroke; Alteplase; Intravenous thrombolysis; Mimics; Stroke; Stroke mimics; Tenecteplase
    • Accession Number:
      WGD229O42W (Tenecteplase)
      EC 3.4.21.68 (Tissue Plasminogen Activator)
      0 (Fibrinolytic Agents)
    • Publication Date:
      Date Created: 20231116 Date Completed: 20231117 Latest Revision: 20231119
    • Publication Date:
      20231215
    • Accession Number:
      PMC10647039
    • Accession Number:
      10.1186/s12883-023-03425-x
    • Accession Number:
      37968581