To identify and analyze the clinical characteristics of the patients that had stroke-like symptoms (stroke mimics) on presentation and received IV tPA but subsequently were found not to have an ischemic stroke.

Intravenous tissue plasminogen activator (tPA) administration within 4.5 hours of last known normal to the patients presenting with symptoms of stroke is the standard of care. Stroke mimics are a diverse group that is difficult to identify. They present with acute-onset focal neurological deficits, however further work up including MRI (magnetic resonance imaging) of the brain show no evidence of stroke or TIA. The aim of our study is to identify such patients and understand their clinical characteristics.

We retrospectively reviewed the medical records and analyzed all the patients in a span of one year that presented with stroke like symptoms and received IV tPA. 

We identified a total of 107 pts that received tPA in a span of year at our institute. Among them there were 11 patients that showed no changes in the DWI sequence of MRI imaging and did not have stroke as their discharge diagnosis. Overall, we found that stroke mimics compromise 10.2 % of the pts that got administered tPA. The age of this group ranged from 38-73. There were seven women and four men. The NIHSS at the time of presentation ranged from 3-19. We identified three patients with hypertensive crisis, two with cervical radiculopathy, two with suspicion of conversion disorder: one each with normal pressure hydrocephalus, sepsis with neurosyphilis, pulmonary embolism with aortic regurgitation and methamphetamine abuse. Majority of them presented with unilateral weakness along with facial weakness and speech difficulties.

We conclude that in our patient population, only few patients were found to be stroke mimics.