stroke mimics and thrombolysis

14 Feb


I am about to give this patient with stroke-like symptoms a thrombolytic. What if it turns out not to be a stroke?

Article by Guillan et al: 

Stroke mimics treated with thrombolysis: further evidence on safety and distinctive clinical features.

621 patients were treated with IV-tPA

  • 606 (97.5%) were ischemic stroke (IS)
  • 15 (2.4%) were stroke mimic (SM)


aetiology of stroke mimics:

  • somatoform disorders (5),
  • headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome (3),
  • herpetic encephalitis (2)
  • glial tumours (2),
  • migraine with aura (1)
  • focal seizure (1)
  • cortical vein thrombosis (1)

No intracranial haemorrhage or disability at 3 months in any SM patient.



no one with a stroke mimic ended up with a head bleed after TPA (though the risk of ICH after TPA is ~1 in 20, so with 15 stroke mimic patients, take this with a grain of salt).

small numbers of stroke mimics to pull conclusions from, but maybe its a good thing that most patients given TPA (97.5%) actually had an ischemic stroke (so we’re decent at identifying stroke patients, at least)


stroke treatment with thrombolytics a bit controversial as it is; check out this NNT review for a quick lowdown


Submitted by H. Reed-Day.


References: article; NNT review; picture


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