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Can rt-PA be Administered to the Wrong Patient? Two Patients with Somatoform Disorder

Published online by Cambridge University Press:  02 December 2014

Mikael S. Mouradian
Affiliation:
Division of Neurology, Department of Medicine, Canada
Jennifer Rodgers
Affiliation:
Division of Clinical Psychology, Department of Psychiatry, Canada
Jodi Kashmere
Affiliation:
Division of Neurology, Department of Medicine, Canada
Glen Jickling
Affiliation:
Faculty of Medicine, Canada
Jennifer McCombe
Affiliation:
Faculty of Medicine, Queens University, Kingston, Ontario, Canada
Derek J Emery
Affiliation:
Division of Neuroradiology, Department of Radiology; University of Alberta, Canada
Andrew M. Demchuk
Affiliation:
Department of Clinical neurosciences, University of Calgary, Alberta, Canada
Ashfaq Shuaib
Affiliation:
Division of Neurology, Department of Medicine, Canada
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Abstract

Background:

Intravenous rt-PA (IV rt-PA) for acute stroke has raised many concerns, including its inadvertent use in patients presenting with acute stroke-like symptoms as the expression of their somatoform disorder. Diagnosis of the somatoform disorder is often delayed, and thrombolytics in these patients for their stroke-like presentation subjects them to risk for hemorrhage.

Methods:

The presentation, neurological findings, and the therapeutic decision making was audited in 85 patients who received IV rt-PA for a diagnosis of acute stroke. All the surviving patients were re-examined neurologically at least three months after IV rt-PA. Baseline and follow-up brain CT scans were re-reviewed by a neuroradiologist who was blinded to clinical presentation and outcome. Patients whose clinical presentation, brain CT and neurological outcome did not fit into known or expected anatomical and clinical patterns of stroke underwent psychological assessment using the Minnesota Multiphasic Personality Inventory-2.

Results:

In two patients three stroke-like presentations of somatoform disorder inadvertently were treated with IV rt-PA. This was primarily caused by abbreviated neurological examination and narrow differential diagnosis.

Interpretation:

Patients with somatoform disorder may present with symptoms mimicking acute stroke. Under the time constraints of IV rt-PA use, a diagnosis of somatoform disorder can be missed, subjecting such patients to the potential complications of thrombolytics.

Type
Case Report
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

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