Khan et al developed a simple score for identifying a patient with a possible stroke mimic. This can help to identify a patient who may not need thrombolysis. The authors are from SIU in Springfield, Illinois.
Patient selection: stroke-like symptoms, within time window for thrombolytics
Parameters:
(1) age in years
(2) number of risk factors for stroke (hypertension, diabetes, atrial fibrillation, hyperlipidemia)
(3) history of migraine headaches
(4) history of epilepsy
(5) history of psychiatric illness
Parameter
Finding
Points
age in years
< 50 years
2
50 to 70
1
> 70
0
number of risk factors for stroke
0
3
atrial fibrillation (AF)
0
1 without AF
2
2 or 3 without AF
1
history of migraines
no
0
yes
2
history of epilepsy
no
0
yes
1
history of psychiatric illness
no
0
yes
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• If the score is <= 5 then the patient should undergo routine stroke therapy.
• If the score >= 6 then the patient should have a rapid sequence MRI of the brain. If there is evidence of stroke then the patient undergoes routine stroke therapy. If the MRI is negative then no further workup is performed.
Score
Percent Stroke
0
96%
1
92%
2
84%
3
70%
4
53%
5
33%
6
19%
7-9
< 15%
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