Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, November 19, 2018

Migraines Mimicking Stroke Still Pose Diagnostic Challenges

So you better plan on having the classic stroke symptoms(crooked smile, garbled speech, arms not able to lift together). I only had the arms problem and I was not even tested for that, I was fully lucid and conversant, no idea about my smile.  

Migraines Mimicking Stroke Still Pose Diagnostic Challenges


Migraine with aura responsible for 18% of improper thrombolytic treatments

  • by Contributing Writer, MedPage Today
SCOTTSDALE, Ariz. -- Migraine with aura is one of the three most common conditions, along with seizures and psychiatric disorders, that mimic stroke and can lead to inappropriate thrombolytic treatment, a researcher said here.
"There are other forms of stroke mimics, but these are the big three," said R. Allan Purdy, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, at a plenary session at the American Headache Society Scottsdale Headache Symposium.
"There can't be a neurologist or healthcare professional who hasn't thought about what might happen if tissue plasminogen activator (tPA) is given to a patient with migraine," Purdy noted. "Since 1995 when tPA came out, there's been a concern that, at some point, we might be giving it to a patient with a stroke mimic."
Earlier this year, a systematic review found that migraine with aura was responsible for 1.79% of all emergency stroke unit evaluations, possibly due to efforts to reduce door-to-needle time for tPA (alteplase) stroke treatment. Migraine with aura was the third most common mimic.
Nearly 7% of tPA administrations were for non-stroke events, with migraine making up about 18% of these. Despite a lack of strong supporting data, thrombolysis in migraine with aura appeared to carry an extremely low risk of adverse events (0.01%), the authors concluded.
"This review was important because of what came out almost at the same time, which were the 2018 guidelines for the early management of stroke," said Purdy. Those guidelines stated that "the risk of symptomatic intracranial hemorrhage in the stroke mimic population is quite low; thus, starting IV alteplase is probably recommended in preference over delaying treatment to pursue additional diagnostic studies."
"The key word here is 'probably' -- and this is important to recognize," Purdy said. "On balance, a lot of patients with stroke mimics have been given tPA, and although the untoward event percentage is extremely low, it's never going to be zero."
The aura is the thing to focus on, Purdy pointed out. "It's not the headache that you can analyze and determine whether it's a stroke mimic, because a lot of patients with transient ischemic attack (TIA) and stroke have headache. You have to look at the aura." The secret to distinguishing migraine from stroke may be in cases with a "slow march of a migraine aura over 20 minutes," in contrast to the abrupt onset of aura symptoms in strokes, he said. Unlike stroke, migraine also can involve one side of the tongue, he added.
In the systematic review, migraine patients tended to arrive quickly at the hospital, often within 1 hour of clinical onset. Overall, stroke mimic patients often were younger, more frequently women, had fewer cardiovascular risk factors, and showed psychiatric disorders as the most common comorbidity. The presence of neurological aura in young women, particularly if it involves speech or vision without hemiplegia, could signify a stroke mimic, Purdy noted. While that group also is risk for stroke, especially women who smoke and use oral contraception medication, "this would be a group you would look at very carefully before giving tPA," he said.
"The neurological differential diagnosis is still important in the emergency department," Purdy observed. "One still has to differentiate what's actually going on. This is important; the therapy is not without risk."
It's important to bear in mind that reaching a correct treatment decision requires knowledge of neurovascular anatomy, clinical stroke syndromes, and common mimics -- all while remembering time is brain, Purdy noted. "A quick assessment of patients takes away the opportunity for a reflective assessment, which we were all trained to think about," he said.
Purdy disclosed no relevant relationships with industry.
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