Functional Stroke Mimics: Patient Characteristics, CT-Based Multimodal Imaging and Long-Term Outcome in a Comparative Cohort Study.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2026-05-01 DOI:10.1111/ene.70617

Filipa Bastos, Davide Strambo, Alexander Salerno, Vincent Dunet, Selma Aybek, Patrik Michel

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引用次数: 0

Abstract

Background and purpose: Functional stroke-like episodes (FSMs) are an increasingly recognised stroke mimic with demographic and clinical characteristics that differ from acute ischaemic strokes (AISs) but have unclear long-term outcomes.

Materials and methods: We report retrospective data on consecutive patients with FSM who underwent acute perfusion-CT (PCT) admitted to Lausanne University Hospital (2003-2017). We compared them to all contemporaneous AISs undergoing PCT from the Acute-STroke-Registry-and-Analysis-of-Lausanne (ASTRAL).

Results: Twenty-five FSMs and 3201 control-AISs were included. FSM patients were significantly younger (median 43 vs. 73 years, adjusted odds ratio (OR_adj) 0.92), had a higher incidence of psychiatric disorders (OR_adj 5.33/17.07), and over half had a prior history of neurological and non-neurological functional disorders. FSM patients more often presented decreased vigilance (OR_adj = 9.28) and sensory deficits (OR_adj = 3.87), and less visual field defects (OR_adj = 0.14) and dysarthria (OR_adj = 0.20). FSM patients showed no significant changes on plain-CT and PCT. Acute revascularisation rates were similar in both groups (48% vs. 43%). Follow-up at 3-months revealed significant handicap in 41% of patients, similar to the control group in propensity-score-matched analysis, and lower mortality (0% vs. 20%, p_adj 0.04). After a median of 9 years follow-up, FSM patients failed to functionally improve further and 55% experienced additional functional neurological events.

Conclusion: In this single-centre cohort of consecutive FSMs undergoing acute PCT, we identified distinctive demographic and clinical features, normal CT-based neuroimaging, but still a high thrombolysis rate. Long-term observation revealed a high rate of recurrent functional events and persistent disability, suggesting the need for more effective treatment and regular follow-up.

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功能性脑卒中模拟：患者特征、基于ct的多模态成像和一项比较队列研究的长期结果。

背景和目的：功能性卒中样发作（FSMs）是一种越来越被认可的卒中模拟，具有不同于急性缺血性卒中（ais）的人口学和临床特征，但长期预后不明确。材料和方法：我们报告了2003-2017年在洛桑大学医院连续接受急性灌注ct （PCT）治疗的FSM患者的回顾性数据。我们将他们与来自洛桑急性卒中登记和分析（ASTRAL）的所有同期接受PCT的急性脑卒中患者进行比较。结果：共纳入25个fsm和3201个对照ais。FSM患者明显年轻化（中位43岁vs. 73岁，调整优势比（ORadj） 0.92），精神障碍发生率较高（ORadj 5.33/17.07），超过一半的患者既往有神经和非神经功能障碍史。FSM患者多表现为警觉性下降（ORadj = 9.28）和感觉缺陷（ORadj = 3.87），较少表现为视野缺陷（ORadj = 0.14）和构音障碍（ORadj = 0.20）。两组患者的急性血运重建率相似（48% vs 43%）。3个月的随访显示41%的患者有明显的残疾，在倾向-评分匹配分析中与对照组相似，死亡率较低（0%对20%，padj 0.04）。经过中位9年的随访，FSM患者的功能没有进一步改善，55%的患者经历了额外的功能性神经事件。结论：在这个连续接受急性PCT治疗的fsm单中心队列中，我们发现了独特的人口统计学和临床特征，基于ct的神经影像学正常，但溶栓率仍然很高。长期观察显示复发性功能事件和持续性残疾发生率高，提示需要更有效的治疗和定期随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).