Factitious stroke presenting for acute treatment. |
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| Authors: | J C Hemphil S S Chung |
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| Institution: | 1. Division of Cardiovascular Sciences, University of Manchester, Manchester, UK;2. Department of Accidents and Trauma, Prince Sultan bin Abdelaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia;3. Medical Directorate, North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK;4. University of Sheffield, School of Health and Related Research, Sheffield, UK;5. Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK;1. NMC Specialty Hospital, Dubai, United Arab Emirates;2. Vrije Universiteit Brussel, Brussels, Belgium;3. School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa;4. Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;5. Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands;6. King''s College Hospital, London, United Kingdom;7. First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland;8. Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium;9. 1AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France;10. Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India;1. Stroke Division, Department of Neurology, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, United States;2. Department of Emergency Medicine, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, United States;3. Department of Neurosurgery, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, United States;4. Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Jarvis Hall, #318, Buffalo, NY 14228, United States |
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| Abstract: | Four patients who were ultimately determined to have factitious neurological deficits were initially assessed as meeting eligibility criteria for treatment with intravenous recombinant tissue plasminogen activator (IV rt-PA), or enrollment in an acute stroke study. Two patients presented within the 3-hour IV rt-PA window; two presented between 4 and 6 hours after symptom onset. Evaluation by the Stroke Team responsible for IV rt-PA treatment or clinical study enrollment determined that three patients met all eligibility criteria, except for a fluctuating or rapidly improving deficit; these patients did not receive rt-PA or study enrollment. One patient whose deficit did not fluctuate or improve on Stroke Team evaluation was enrolled in an acute stroke study. Compared with 36 nonfactitious patients who received IV rt-PA or study enrollment, factitious patients were less likely to have facial weakness, aphasia, neglect, or visual field deficit. Because criteria for IV rt-PA and many stroke studies do not currently require imaging of a vascular occlusion or ischemic brain tissue, patients with factitious stroke may appear to meet these eligibility criteria. Physicians experienced in acute stroke evaluation and management are most likely to identify patients with factitious stroke and exclude them from consideration for thrombolysis or stroke study enrollment. |
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