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22. European Stroke Conference Figure 1. (a) Initial CT brain (at presentation), (b) Repeat CT brain at the time of deterioration 48 hours later. 358 © 2013 S. Karger AG, Basel Scientific Programme (a) (b) 146 Interesting and challenging cases Symptomatic vasospasm due to subarachnoid hemorrhage: a dangerous stroke-mimic. Useful-ness of Transcranial Doppler. E. Fernández-Díaz1, I. Díaz-Maroto2, M. Monteagudo-Gómez3, P. Sanchez-Ayaso4, J. García- García5, O. Ayo-Martín6, T. Segura7 Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN1, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN2, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN3, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN4, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN5, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN6, Complejo Hospitalario Universitario de Albacete, Albacete, SPAIN7 Background Stroke treatment has improved significantly in recent years after the implementation of the stroke code. Nevertheless, a quicker treatment should not mean a less safe one. Among all the diseases that may mimic ischemic stroke (IS), there are some etiologies in which thrombolytic therapy (rtPA) could be especially dangerous. Methods To report two cases in which transcranial Doppler (TCD) study allowed us to suspect symptomatic vasospasm due to subarachnoid hemorrhage (SAH), avoiding treatment with iv-rtPA Results Two young women were admitted in ER as stroke code for deficitary hemispheric symptoms (less than 3 hours of evolution) and early signs of cerebral ischemia on computed tomography. TCD study, performed after CT scan, showed high-velocity flows in several intracranial arteries. This un-usual finding made us reconsider diagnosis and iv-rtPA treatment was delayed. Angiography showed middle cerebral artery aneurysm and severe vasospasm in both cases. After improving, both patients reported they had suffered severe headaches few days before the onset of deficitary hemispheric symptoms. Conclusion These cases highlight the utility of TCD (an accessible and non-invasive test) in the management of stroke code patients. In our opinion, the potential benefits of TCD study outweigh the time spent in ist realization by skilled neurologists. TCD allow us to consider alternative diagnoses such as vasospasm during the evaluation of patients with suspected acute ischemic stroke.


Karger_ESC London_2013
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