Can rt-PA be Administered to the Wrong Patient? Two Patients with Somatoform Disorder

Mikael S. Mouradian, Jennifer Rodgers, Jodi Kashmere, Glen Jickling, Jennifer McCombe, Derek J. Emery, Andrew M. Demchuk, Ashfaq Shuaib

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Intravenous rt-PA (IV rt-PA) for acute stroke has raised many concerns, including its inadvertent use in patients presenting with acute stroke-like symptoms as the expression of their somatoform disorder. Diagnosis of the somatoform disorder is often delayed, and thrombolytics in these patients for their stroke-like presentation subjects them to risk for hemorrhage. Methods: The presentation, neurological findings, and the therapeutic decision making was audited in 85 patients who received IV rt-PA for a diagnosis of acute stroke. All the surviving patients were re-examined neurologically at least three months after IV rt-PA. Baseline and follow-up brain CT scans were re-reviewed by a neuroradiologist who was blinded to clinical presentation and outcome. Patients whose clinical presentation, brain CT and neurological outcome did not fit into known or expected anatomical and clinical patterns of stroke underwent psychological assessment using the Minnesota Multiphasic Personality Inventory-2. Results: In two patients three stroke-like presentations of somatoform disorder inadvertently were treated with IV rt-PA. This was primarily caused by abbreviated neurological examination and narrow differential diagnosis. Interpretation: Patients with somatoform disorder may present with symptoms mimicking acute stroke. Under the time constraints of IV rt-PA use, a diagnosis of somatoform disorder can be missed, subjecting such patients to the potential complications of thrombolytics.

Original languageEnglish (US)
Pages (from-to)99-101
Number of pages3
JournalCanadian Journal of Neurological Sciences
Issue number1
StatePublished - Feb 2004
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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