Stroke Mimics in the Acute Setting: Role of Multimodal CT Protocol.
Journal
AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
22
06
2021
accepted:
06
10
2021
pubmed:
1
1
2022
medline:
11
3
2022
entrez:
31
12
2021
Statut:
ppublish
Résumé
Ischemic stroke can be mimicked by nonischemic conditions. Due to emphasis on the rapid treatment of acute ischemic stroke, it is crucial to identify these conditions to avoid unnecessary therapies and potential complications. We investigated the performance of the multimodal CT protocol (unenhanced brain CT, CTA, and CTP) to discriminate stroke mimics from acute ischemic stroke. We retrospectively selected multimodal CT studies performed for clinical suspicion of acute ischemic stroke in our center in a 24-month period, including patients with at least 1 follow-up imaging study (brain CT or MR imaging). Hemorrhagic strokes were excluded. We measured the performance of multimodal CT, comparing the original diagnostic results with the final clinical diagnosis at discharge. Among 401 patients, a stroke mimic condition was diagnosed in 89 (22%), including seizures (34.8%), migraine with aura attack (12.4%), conversion disorder (12.4%), infection (7.9%), brain tumor (7.9%), acute metabolic condition (6.7%), peripheral vertigo (5.6%), syncope (5.6%), transient global amnesia (3.4%), subdural hematoma (1.1%), cervical epidural hematoma (1.1%), and dural AVF (1.1%). Multimodal CT sensitivity, specificity, and accuracy were 24.7%, 99.7%, and 83%. Multimodal CT revealed peri-ictal changes in 13/31 seizures and diagnosed 7/7 brain tumors, 1/1 dural AVF, and 1/1 subdural hematoma. CT perfusion played a pivotal diagnostic role. Multimodal CT demonstrated low sensitivity but high specificity in the diagnosis of stroke mimics in the acute setting. The high specificity of multimodal CT allows ruling out stroke and thereby avoiding unnecessary revascularization treatment in patients with diagnosis of a stroke mimic.
Sections du résumé
BACKGROUND AND PURPOSE
Ischemic stroke can be mimicked by nonischemic conditions. Due to emphasis on the rapid treatment of acute ischemic stroke, it is crucial to identify these conditions to avoid unnecessary therapies and potential complications. We investigated the performance of the multimodal CT protocol (unenhanced brain CT, CTA, and CTP) to discriminate stroke mimics from acute ischemic stroke.
MATERIALS AND METHODS
We retrospectively selected multimodal CT studies performed for clinical suspicion of acute ischemic stroke in our center in a 24-month period, including patients with at least 1 follow-up imaging study (brain CT or MR imaging). Hemorrhagic strokes were excluded. We measured the performance of multimodal CT, comparing the original diagnostic results with the final clinical diagnosis at discharge.
RESULTS
Among 401 patients, a stroke mimic condition was diagnosed in 89 (22%), including seizures (34.8%), migraine with aura attack (12.4%), conversion disorder (12.4%), infection (7.9%), brain tumor (7.9%), acute metabolic condition (6.7%), peripheral vertigo (5.6%), syncope (5.6%), transient global amnesia (3.4%), subdural hematoma (1.1%), cervical epidural hematoma (1.1%), and dural AVF (1.1%). Multimodal CT sensitivity, specificity, and accuracy were 24.7%, 99.7%, and 83%. Multimodal CT revealed peri-ictal changes in 13/31 seizures and diagnosed 7/7 brain tumors, 1/1 dural AVF, and 1/1 subdural hematoma. CT perfusion played a pivotal diagnostic role.
CONCLUSIONS
Multimodal CT demonstrated low sensitivity but high specificity in the diagnosis of stroke mimics in the acute setting. The high specificity of multimodal CT allows ruling out stroke and thereby avoiding unnecessary revascularization treatment in patients with diagnosis of a stroke mimic.
Identifiants
pubmed: 34969667
pii: ajnr.A7379
doi: 10.3174/ajnr.A7379
pmc: PMC8985681
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
216-222Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 by American Journal of Neuroradiology.
Références
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e397-403
pubmed: 23680681
Stroke. 2006 Mar;37(3):769-75
pubmed: 16484610
Int J Stroke. 2016 Jan;11(1):85-92
pubmed: 26763024
AJNR Am J Neuroradiol. 2011 Oct;32(9):1570-7
pubmed: 21051510
Arch Neurol. 1995 Nov;52(11):1119-22
pubmed: 7487564
Acta Radiol. 2006 Oct;47(8):878-81
pubmed: 17050372
Stroke. 2009 Apr;40(4):1522-5
pubmed: 19164790
J Comput Assist Tomogr. 2001 Jul-Aug;25(4):520-8
pubmed: 11473180
BMJ. 2012 Oct 24;345:e6717
pubmed: 23097549
AJNR Am J Neuroradiol. 2001 Oct;22(9):1795-7
pubmed: 11673182
Stroke. 2020 Mar;51(3):1017-1024
pubmed: 32008460
J Stroke Cerebrovasc Dis. 2008 Jan-Feb;17(1):23-5
pubmed: 18190817
Cephalalgia. 2014 Oct;34(11):870-6
pubmed: 24554619
Eur J Neurol. 2021 Jun;28(6):1939-1948
pubmed: 33609295
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
AJNR Am J Neuroradiol. 2015 Sep;36(9):1580-8
pubmed: 25614476
Lancet. 1982 Feb 6;1(8267):328-31
pubmed: 6120323
Int J Emerg Med. 2012 Feb 29;5:12
pubmed: 22377097
Stroke. 2009 Jun;40(6):2276-93
pubmed: 19423857
AJR Am J Roentgenol. 2009 Dec;193(6):1629-38
pubmed: 19933658
J Clin Neurol. 2018 Oct;14(4):586-587
pubmed: 30284769
Case Rep Neurol Med. 2014;2014:673230
pubmed: 24716022
J Am Coll Radiol. 2013 Nov;10(11):828-32
pubmed: 23948676
Neurology. 2018 Nov 13;91(20):e1918-e1927
pubmed: 30333164
AJNR Am J Neuroradiol. 2021 Jan;42(1):49-56
pubmed: 33431502
Cerebrovasc Dis. 2013;35(6):493-501
pubmed: 23736122
Eur J Radiol. 2017 Nov;96:133-144
pubmed: 28551302
Case Rep Radiol. 2018 May 6;2018:3538645
pubmed: 29854534
AJNR Am J Neuroradiol. 2012 Sep;33(8):1546-52
pubmed: 22517281
PLoS One. 2017 May 17;12(5):e0176622
pubmed: 28520753
Radiology. 2004 Oct;233(1):79-86
pubmed: 15340177
Stroke. 2013 Jul;44(7):2064-89
pubmed: 23652265
Stroke. 2015 May;46(5):1281-7
pubmed: 25791717