急诊卒中模拟病的鉴别及静脉溶栓的安全性研究进展

doi:10.3969/j.issn.1673-5765.2018.11.017

摘要/Abstract

摘要：

卒中模拟病（stroke mimics，SM）为入院时有突发语言、肢体活动障碍、意识改变等类似卒中发作症状，出院诊断明确为急性缺血性卒中以外的其他疾病的一组临床综合征, 准确快速的诊断卒中患者，并且及时的治疗能够明显改善患者预后，所以识别SM和缺血性卒中的不典型表现尤为重要。本文主要介绍了从临床症状特点及辅助检查工具（量表和影像学检查）来鉴别急诊的SM，同时对其静脉溶栓的安全性进行了阐述。

文章导读： 本文介绍了急诊卒中模拟病的常见临床表现及鉴别的辅助工具，评价了对其静脉溶栓的安全性，以期对急诊快速诊断急性缺血性卒中有所帮助。

关键词: 卒中模拟病; 急性缺血性卒中; 静脉溶栓

Abstract:

Stroke mimics (SM) are a group of nonvascular neurological clinical syndrome which closely resemble stroke symptoms (sudden language, movement and consciousness disturbance, etc.) at admission, while the final diagnosis are not stroke. To recognize the non-typical symptoms between SM and ischemic stroke is very critical for diagnosing stroke correctly and rapidly, which can significantly improve the prognosis. This article reviewed the identification of emergency SM in terms of clinical characteristics and auxiliary examination (scales and imaging examination), and the safety of intravenous thrombolysis in acute SM.

Key words: Stroke mimics; Acute ischemic stroke; Intravenous thrombolysis

范学慧, 钟镝, 陈洪苹, 李国忠, 赵秀丽. 急诊卒中模拟病的鉴别及静脉溶栓的安全性研究进展[J]. 中国卒中杂志, 2018, 13(11): 1211-1216.

FAN Xue-Hui, ZHONG Di, CHEN Hong-Ping, LI Guo-Zhong, ZHAO Xiu-Li. Advance in Safety of Intravenous Thrombolysis in Emergency Stroke Mimics and Its Identification[J]. Chinese Journal of Stroke, 2018, 13(11): 1211-1216.

参考文献

[1] MARTINEZ-RAMIREZ S，DELGADO-MEDEROS

R，MARTÍ-VILALTA J L，et al. Safety of tPA in

stroke mimics and neuroimaging-negative cerebral

ischemia：swift or sure? The acceptable rate of

neurovascular mimics among IV tPA-treated

patients[J/OL]. Neurology，2010，75（20）：1853-1854.

[2] MERINO J G，LUBY M，BENSON R T，et al.

Predictors of acute stroke mimics in 8187 patients referred to a stroke service[J/OL]. J Stroke

Cerebrovasc Dis，2013，22（8）：e397-e403. https：//

doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.018.

[3] GUILLAN M，ALONSOCANOVAS A，

GONZALEZVALCARCEL J，et al. Stroke mimics

treated with thrombolysis：further evidence on safety

and distinctive clinical features[J]. Cerebrovasc Dis，

2012，34（2）：115-120.

[4] MEHTA S，VORA N，EDGELL R C，et al. Stroke

mimics under the drip-and-ship paradigm[J]. J

Stroke Cerebrovasc Dis，2014，23（5）：844-849.

[5] DURSTON W. Stroke mimics and intravenous

thrombolysis[J]. Ann Emerg Med，2012，60（2）：27-

32.

[6] UCHINO K，MASSARO L，HAMMER M D.

Transient Ischemic Attack after Tissue Plasminogen

Activator：Aborted Stroke or Unnecessary Stroke

Therapy?[J]. Cerebrovasc Dis，2010，29（1）：57-61.

[7] WINKLER D T，FLURI F，FUHR P，et al.

Thrombolysis in stroke mimics：frequency，clinical

characteristics，and outcome[J]. Stroke，2009，40

（4）：1522-1525.

[8] CHANG J，TELEB M，YANG J P，et al. A model to

prevent fibrinolysis in patients with stroke mimics[J].

J Stroke Cerebrovasc Dis，2012，21（8）：839-843.

[9] TSIVGOULIS G，ALEXANDROV A V，CHANG

J，et al. Safety and outcomes of intravenous

thrombolysis in stroke mimics：a 6-year，singlecare

center study and a pooled analysis of reported

series[J]. Stroke，2011，42（6）：1771-1774.

[10] GIBSON L M，WHITELEY W. The differential

diagnosis of suspected stroke：a systematic review[J].

J R Coll Physicians Edinb，2013，43（2）：114-118.

[11] GARGALAS S，WEEKS R，KHANBOURNE N，

et al. Incidence and outcome of functional stroke

mimics admitted to a hyperacute stroke unit[J]. J

Neurol Neurosurg Psychiatry，2017，88（1）：2-6.

[12] ZINKSTOK S，ENGELTER S，GENSICKE H，et al.

Safety of Thrombolysis in Stroke Mimics：Results

From a Multicenter Cohort Study[J]. Stroke，2013，

44（4）：1080-1084.

[13] SIVAKUMARAN P，GILL D，MAHIR G，et

al. A Retrospective Cohort Study on the Use of

Intravenous Thrombolysis in Stroke Mimics[J]. J

Stroke Cerebrovasc Dis，2016，25（5）：1057-1061.

[14] CHEN Y，BOGOSAVLJEVIC V，LEYS D，et al.

Intravenous thrombolytic therapy in patients with

stroke mimics：baseline characteristics and safety

profile[J]. Eur J Neurol，2011，18（10）：1246-1250.

[15] QUENARDELLE V，LAUER-OBER V，

ZINCHENKO I，et al. Stroke Mimics in a Stroke

Care Pathway Based on MRI Screening[J].

Cerebrovasc Dis，2016，42（3-4）：205-212.

[16] KOSTULAS N，LARSSON M，KALL T，et

al. Safety of thrombolysis in stroke mimics：an

observational cohort study from an urban

teaching hospital in Sweden[J/OL]. BMJ Open，

2017，7（10）：e016311. https：//doi.org/10.1136/

bmjopen-2017-016311.

[17] SYLAJA P N，DZIALOWSKI I，KROL A，et al.

Role of CT angiography in thrombolysis decisionmaking

for patients with presumed seizure at stroke

onset[J]. Stroke，2006，37（3）：915-917.

[18] FÖRSTER A，GRIEBE M，WOLF M，et al. How

to identify stroke mimics in patients eligible for

intravenous thrombolysis?[J]. J Neurol，2012，259

（7）：1347-1353.

[19] SARIKAYA H，YILMAZ M，LUFT A，et al.

Different Pattern of Clinical Deficits in Stroke

Mimics Treated with Intravenous Thrombolysis[J].

Eur Neurol，2012，68（6）：344-349.

[20] BERGLUND A，SVENSSON L，WAHLGREN

N，et al. Face Arm Speech Time Test use in the

prehospital setting，better in the ambulance than in

the emergency medical communication center[J].

Cerebrovascular Diseases，2014，37（3）：212-216.

[21] CHEN S，SUN H，LEI Y，et al. Validation of the

Los Angeles Pre-Hospital Stroke Screen（LAPSS）

in a Chinese Urban Emergency Medical Service

Population [J/OL]. Plos One，2013，8（8）：e70742.

https：//doi.org/10.1371/journal.pone.0070742.

[22] BABL F E，ADRIANA Y C，MOSLEY I T，et al.

Can the FAST and ROSIER adult stroke recognition

tools be applied to confirmed childhood arterial

ischemic stroke?[J/OL]. Bmc Pediatrics，2011，11：

93-100. https：//doi.org/10.1186/1471-2431-11-93.

[23] GOYAL N，TSIVGOULIS G，MALE S，et al. FABS：

An Intuitive Tool for Screening of Stroke Mimics in

the Emergency Department[J]. Stroke，2016，49（9）：

2216-2220.

[24] QIN X，ZHAO S，YIN L，et al. Validation

of simplified FABS scale to predict stroke

mimics in a Chinese population undergoing

intravenous thrombolysis[J/OL]. Clin Neurol

Neurosurg，2017，161：1-5. https：//doi.org/10.1016/

j.clineuro.2017.07.013.

[25] ALI S，VISWANATHAN A，SINGHAL A，et al.

The TeleStroke mimic（TM）-score：a prediction

rule for identifying stroke mimics evaluated in

a Telestroke Network[J/OL]. J Am Heart Assoc，

2014，3（3）：e000838. https：//doi.org/10.1161/

JAHA.114.000838.

[26] National Institute of Neurological Disorders

and Stroke rt-PA Stroke Study Group. Tissue

plasminogen activator for acute ischemic stroke[J].

N Engl J Med，1995，333（24）：1581-1587.

[27] HACKE W，KASTE M，BLUHMKI E，et al.

Thrombolysis with alteplase 3 to 4. 5 hours after

acute ischemic stroke[J]. N Engl J Med，2008，359

（13）：1317-1329.

[28] CHERNYSHEV O Y，MARTINSCHILD S，

ALBRIGHT K C，et al. Safety of tPA in stroke

mimics and neuroimaging-negative cerebral

ischemia[J]. Neurology，2010，74（17）：1340-1345.

[29] SCHELLINGER P D，THOMALLA G，FIEHLER J，

et al. MRI-based and CT-based thrombolytic therapy

in acute stroke within and beyond established time

windows：an analysis of 1210 patients[J]. Stroke，

2007，38（10）：2640-2645.

[30] RACT I，FERRÉ J C，RONZIÈRE T，et al.

Improving detection of ischemic lesions at 3 Tesla

with optimized diffusion-weighted magnetic

resonance imaging[J]. J Neuroradiol，2014，41（1）：

45-51.

[31] ALBERS G W. Expanding the window for

thrombolytic therapy in acute stroke. The potential

role of acute MRI for patient selection[J]. Stroke，

1999，30（10）：2230-2237.

[32] TISSERAND M，NAGGARA O，LEGRAND L，et

al. Patient "candidate" for thrombolysis：MRI is

essential[J]. Diagn Interv Imaging，2014，95（12）：

1135-1144.

[33] EICHEL R，HUR T B，GOMORI J M，et al. Use

of DWI-only MR protocol for screening stroke

mimics[J]. J Neurol Sci，2013，328（1-2）：37-40.

[34] CHALELA J，KIDWELL C，NENTWICH L，et

al. Magnetic resonance imaging and computed

tomography in emergency assessment of patients

with suspected acute stroke：a prospective

comparison[J]. Lancet，2007，369（9558）：293-298.

[35] AY H，BUONANNO F S，RORDORF G，et al.

Normal diffusion-weighted MRI during stroke-like

deficits[J]. Neurology，1999，52（9）：1784-1792.

[36] GOYAL N，MALE S，AL WAFAI A，et al. Cost

burden of stroke mimics and transient ischemic

attack after intravenous tissue plasminogen activator

treatment[J]. J Stroke Cerebrovasc Dis，2015，24（4）：

828-833.

[37] TSIVGOULIS G，ZAND R，KATSANOS A H，et al.

Safety of Intravenous Thrombolysis in Stroke Mimics：

Prospective 5-Year Study and Comprehensive Meta-

Analysis[J]. Stroke，2015，46（5）：1281-1287.

[38] GRIMM S A，DEANGELIS L M. Intratumoral

hemorrhage after thrombolysis in a patient with

glioblastoma multiforme[J]. Neurology，2007，69

（9）：936.