Stroke mimics and tPA treatment

One of the problems encountered regularly by stroke and emergency room physicians is the dreaded stroke mimic. These are diseases that look and feel like a stroke but aren't. These are rare, but they pose a problem when it comes to tPA treatment, as this miraculous drug does carry a small risk of fatal bleeding, and thus we only like to use it if it is truly necessary. In the past the question has lingered in our minds. How many of the people with stroke mimics we treat with tPA actually end up with intracranial bleeding as a result of treatment?

A small study out of Switzerland just showed that giving tPA to people with these rare stroke-like events actually does not cause adverse effects. Although the study was small, it showed that only about 2.8% of patients were misdiagnosed with a stroke and of those who got treated none had intracranial bleeding. The results are reassuring. Hopefully a larger trial is under way to confirm these results, which once ratified, will take a lot of weight off the shoulders of emergency room and stroke physicians who deal with stroke patients.

What is a stroke?
The golden three hour tPA window
Seizures after stroke