Multiple Administrations of Intravenous Thrombolytic Therapy to a Stroke Mimic

Ava L. Liberman, Daniel Antoniello, Steven Tversky, Michael G. Fara, Cen Zhang, Lindsey Gurin, Sara K. Rostanski

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Patients who present emergently with focal neurological deficits concerning for acute ischemic stroke can be extremely challenging to diagnose and treat. Unnecessary administration of thrombolytics to potential stroke patients whose symptoms are not caused by an acute ischemic stroke—stroke mimics—may result in patient harm, although the overall risk of hemorrhagic complications among stroke mimics is low. Case Report: We present a case of a stroke mimic patient with underlying psychiatric disease who was treated with intravenous alteplase on four separate occasions in four different emergency departments in the same city. Although he did not suffer hemorrhagic complications, this case highlights the importance of rapid exchange of health information across institutions to improve diagnostic quality and safety. Why Should an Emergency Physician Be Aware of This?: Increased awareness of stroke mimics by emergency physicians may improve diagnostic safety for a subset of high-risk patients. Establishing rapid cross-institutional communication pathways that are integrated into provider's workflows to convey essential patient health information has potential to improve stroke diagnostic decision-making and thus represents an important topic for health systems research in emergency medicine.

Original languageEnglish (US)
Pages (from-to)e133-e136
JournalJournal of Emergency Medicine
Issue number3
StatePublished - Mar 2020


  • acute ischemic stroke
  • diagnostic error
  • health information exchange
  • psychiatry
  • stroke mimic

ASJC Scopus subject areas

  • Emergency Medicine


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