Letter by Radecki regarding article, "safety of thrombolysis in stroke mimics: results from a multicenter cohort study".
Letter by Radecki regarding article, "safety of thrombolysis in stroke mimics: results from a multicenter cohort study".
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Radecki 关于文章“模拟中风溶栓的安全性：多中心队列研究的结果”的信函。
DOI：
10.1161/strokeaha.113.002040
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发表时间：
2013
期刊：
影响因子：
8.3
通讯作者：
Radecki,RyanP
中科院分区：
文献类型：
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作者：
Radecki,RyanP
我怀着极大的兴趣阅读了最近关于识别和治疗中风拟态（SM）的出版物。Zinkstok等人1描述了在其多中心队列中接受溶栓治疗的SM发生率极低，与其他已发表文献不同。格雷罗等人2在其社论中评论说，这种低发生率可能是SM诊断标准非常狭窄的结果，需要有令人信服的替代诊断。此外，格雷罗等人2认为，缺乏使用磁共振成像（MRI）和弥散加权序列（DWI）作为验证性研究，削弱了区分急性缺血性卒中（AIS）和SM的能力。格雷罗等人2还认为DWI MRI在记录避免卒中发生率方面的作用。然而，Freeman等人3的研究结果似乎表明，溶栓治疗不会导致AIS的DWI MRI病变消退，这并不令人惊讶。这对溶栓治疗后神经影像学阴性脑缺血4代表避免卒中的前提提出了质疑。相反，这些患者应该被认为是可能的SM和AIS的可能误诊。这些发现的后果可能是严重低估了SM的发生率。Zinkstok等人在文献综述中使用DWI MRI报告，学术中心接受溶栓治疗的SM的真实发生率可能在6.5%至15.5%之间。1当然，社区环境中SM的发生率更高，可能接近格雷罗等人2指出的25%至29%。
It is with great interest I read the recent publications regarding identification and treatment of stroke mimics (SM). Zinkstok et al1 describe an exceedingly low incidence of SM treated with thrombolytic therapy in their multicenter cohort, atypical of other published literatures. Guerrero et al, 2 in their editorial, comment this low incidence is likely the result of very narrow criteria for diagnosis of SM, requiring the presence of a convincing alternative diagnosis. Furthermore, Guerrero et al2 suggest the lack of use of magnetic resonance imaging (MRI) with diffusion-weighted sequences (DWI) as a confirmatory study impaired their ability to discriminate acute ischemic stroke (AIS) from SM.Guerrero et al2 also suggest a role for DWI MRI to document the incidence of averted stroke. However, the findings by Freeman et al3 seem to indicate, unsurprisingly, that thrombolytic therapy does not result in resolution of DWI MRI lesions in AIS. This casts doubt on the premise of neuroimaging negative cerebral ischemia4 representing averted stroke after thrombolytic therapy. Rather, these patients ought be considered likely SM and possible misdiagnosis of AIS. The ramification for these findings may be substantial underestimation of the rate of SM. The true incidence of SM treated with thrombolytic therapy likely ranges between 6.5% and 15.5% at academic centers, as reported by those using DWI MRI in the literature review by Zinkstok et al. 1 Certainly, the rate of SM will be higher in community settings, likely approaching the 25% to 29% noted by Guerrero et al. 2