Pseudoictus en el código ictus. Frecuencia, diagnóstico, tratamiento y destino

• Autores: D. Geffner Sclarsky, A. Simón Gozalbo, C. Soriano Soriano, C. Vilar, Berta Claramonte Clausell, Antonio Belenguer Benavides
• Localización: Emergencias: Revista de la Sociedad Española de Medicina de Urgencias y Emergencias, ISSN 1137-6821, Vol. 26, Nº. 6, 2014, págs. 437-442
• Idioma: español
• Títulos paralelos:
  • Stroke mimics in stroke code activations: frequency, diagnoses, treatment, and discharge destination
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivos: Conocer la frecuencia, diagnóstico, tratamiento trombolítico y destino de los pseudoictus (PI) atendidos como código ictus (CI), y valorar el impacto de incluir a mayores de 80 años.

    Método: Estudio prospectivo de una serie consecutiva de pacientes atendidos como CI, durante 50 meses, en los que se empleó tomografía computarizada craneal como prueba de neuroimagen. Se compara el primer periodo (2008-2010) en el que se siguieron los criterios SITS-MOST, con el segundo periodo (2010-2012) que se amplía la ventana temporal y se suprime el límite superior de edad. El diagnóstico se agrupa en 2 categorías: ictus (transitorio o establecido, que incluye infartos cerebrales, ataques isquémicos transitorios y hemorragias intracerebrales) y PI.

    Resultados: Se activaron 1.450 CI, de los que 288 se diagnostiaron como PI: 19,9% (IC95%: 17,7-21,9%). Éstos presentaron menor edad y mayor frecuencia de mujeres. En el segundo periodo, aumentaron los mayores de 80 años (6,0% vs 22,6%, p < 0,001) y los PI disminuyeron del 23,8% al 16,2% (p 0,04). En mayores de 80 años, los PI son menos frecuentes (14,5% vs 20,4% p = 0,004). Los diagnósticos más frecuentes entre los PI son: crisis epiléptica 25,6% (IC 95%: 18,2-28,3%), síncope 16,8% (12,1-21,5%) y encefalopatía por enfermedad sistémica 16,4% (11,7-21,1%). Se trombolisaron 3 PI (1,0% IC95%: 0,2-3,0%) sin complicaciones hemorrágicas, que representan el 1,2% de los 257 trombolisados. El 46% (36,1-48,1%) de PI ingresaron en el hospital, y un 47,4% fue seguido por neurología.

    Conclusiones: El diagnóstico de PI es frecuente y básicamente clínico, donde una valoración neurológica experta es recomendable. La inclusión de mayores de 80 años se asoció a una reducción de PI.

  • English

    Objectives: To determine the frequency, of stroke mimics in stroke code activations, to analyze diagnoses, use of thrombolytic therapy and the discharge destinations of these patients; and to estimate the impact on these variables when patients over the age of 80 years are included.

    Methods: Prospective study of consecutive patients attended after stroke code activation; the study period was 50 months and the diagnostic image used was cranial computed tomography (CT). We compared the first period (2008-2010), in which we applied the SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study) criteria, to a second period (2010-2012), in which the time window for treatment was enlarged and there was no upper age limit for applying the criteria. Patients were grouped in 2 categories: stroke (transient or established, including cerebral infarction, transient ischemic attacks, and intracerebral hemorrhage) and pseudo-stroke (conditions mimicking stroke).

    Results: Stroke code was activated 1450 times; 288 cases were diagnosed as stroke mimics (19.9%; 95% CI, 17.7%-21.9%). This group was younger and included more women. In the second period, in which more patients over 80 years of age were attended (6.0% in the first period vs. 22.6% in the second, P<.001), the percentage of cases diagnosed as stroke mimics decreased (23.8% in the first period, 16.2% in the second; P<.001). Mimics were less frequent in patients over the age of 80 years (14.5% vs. 20.4% in younger patients, P=.004). The most frequent diagnoses in patients with conditions mimicking stroke were epileptic seizures (15.6%; 95% CI, 18.2%-28.3%), syncope (16.8%; 95% CI, 12.1%-21.5%), and encephalopathy due to systemic disease (16.4%; 95% CI, 11.7%-21.1%). Thrombolytic therapy was used in 3 patients with mimics (1%; 95% CI, 0.2%-3.0%) without hemorrhagic complications, which occurred in 1.2% of the 257 patients under this therapy. Forty-six percent of the patients with mimics were hospitalized (95% CI, 36.1%-48.1%); 47.4% were evaluated by a neurologist.

    Conclusions: Stroke mimics are common and diagnosis is essentially clinical; evaluation by a neurologist is advisable. The frequency of stroke mimics was lower when patients over the age of 80 years were considered.