Friday, September 09, 2016

TPA administration in patients with stroke mimic

In patients with stroke mimic one would expect a lower incidence of head bleed as compared to patients with actual stroke because their brain tissues are not as friable. Reported experience confirms that this is the case as pointed out in this review. The incidence of head bleed in stroke mimic is in fact much lower. Comforting as that may seem the perspective offered by the article warrants emphasis:

In summary, the rate of sICH in patients with stroke mimic who receive intravenous thrombolytics is low in published data, although this estimate may be lower than that observed in clinical practice.9 Patients with stroke mimics generally were younger, were women, and had lower NIHSS scores. Fully functional outcome was 3-fold more likely for patients with stroke mimic compared with that for AIS patients. However, the risk of causing harm to even 1 patient given intravenous thrombolytics in the setting of a stroke mimic is concerning,

1 comment:

Anonymous said...

Having had two stroke mimics and being the subject of a Code Stroke, I've been keenly interested in learning enough about tPA to form an advance directive in the event of a real ischemic stroke. I'm also concerned that I could receive tPA in the event of another mimic when I have lost the capacity to make my own decisions. There are, no doubt, individuals who have AF, a history of TIA or mild strokes, or who are otherwise at risk who are interested in making advance directives, especially given tPA's risks.

Unfortunately, the material available for laypersons is oversimplified and designed for emergency decision making and lacks nuance. Much of the medical literature that's not behind paywalls is too dense for even a university educated person without a background in medicine. I've had to rely on blogs such as this for an introduction to the subject to make an attempt at the literature.

Would anyone out there be interested in writing a primer for the educated layperson? I'm sure I wouldn't be the only grateful patient.