Korean J Neurotrauma.  2018 Apr;14(1):20-23. 10.13004/kjnt.2018.14.1.20.

Improper Use of Thrombolytic Agents in Acute Hemiparesis Following Misdiagnosis of Acute Ischemic Stroke

• Kim MC
• Kim SW

• KMID: 2410916
• DOI: http://doi.org/10.13004/kjnt.2018.14.1.20

Abstract

OBJECTIVE
Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke.
METHODS
We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis. Subsequently, emergent computed tomography scan showed no intracranial hemorrhage. Clinical findings including neurological deficits, clinical course, and related complications were detected and analyzed.
RESULTS
Acute hemiparesis was observed in the following conditions: spontaneous spinal epidural hematoma, Brown-Séquard syndrome caused by cervical disc herniation, cervical epidural abscess, hypoglycemia in the presence of an old stroke, and seizure or convulsion disorder. Although acute hemiparesis was regarded as a contraindication, inappropriate TPA administration did not aggravate the neurological condition in any of the patients who required surgery.
CONCLUSION
Upon presentation of acute hemiparesis, various conditions mimicking cerebral stroke should be considered to avoid misdiagnosis. We suggest that physicians should exercise caution when prescribing thrombolytic agents.

Keyword

Paresis; Stroke; Tissue plasminogen activator

MeSH Terms

Diagnostic Errors*
Emergency Service, Hospital
Epidural Abscess
Fibrinolytic Agents*
Hematoma, Epidural, Spinal
Humans
Hypoglycemia
Intracranial Hemorrhages
Paresis*
Seizures
Stroke*
Tissue Plasminogen Activator
Fibrinolytic Agents
Tissue Plasminogen Activator