Complicated Migraines treated with Thrombolysis as an Ischemic Stroke mimic via Telestroke

Objective: We sought to describe patients who received intravenous tissue plasminogen activator (IVtPA) for possible stroke via telestroke network who were ultimately diagnosed with complicated migraines. Background: Complicated migraine is a recognized cause of focal neurological deficits that can mimic acute ischemic stroke. Design/Methods: With IRB approval, we retrospectively reviewed 149 patients who received IVtPA via telestroke from March 1, 2017 to October 1, 2017. Complicated migraine was defined as neurological symptoms attributed to migraine without evidence of ischemia on CT brain perfusion imaging (CTP) or infarct on MRI brain diffusion weighted images (DWI). Data was abstracted on demographics, neuroimaging, National Institutes of Health Stroke Scale (NIHSS), and clinical presentation. Results: Among 149 patients who received IVtPA via telestroke network, 11 (7.4 %) were diagnosed with complicated migraine. Among the patient with complicated migraine, the mean age was 50 years (range, 38 to 81), 8 (73%) were female, and all patients were white. Initial mean NIHSS was 6.4 (range, 3 to 15) and mean IVtPA time administered was 2.6 hours (range, 1.1 to 4.6). In 8 patients (73%), neurological symptoms lasted > 24 hours. Five patients (45%) reported similar prior episodes and 8 (74%) presented with headache. The most common presentation was hemiparesis in 10 patients (91%). All 11 patients had CTP which were negative. The mean time to CTP was 4.1 hours (range, 2.3 to 7.1). Most (91%) had DWI performed and all were negative for acute infarct. The mean time to DWI was 18 hours after LKN (range, 5.5 to 45 hours). There were no hemorrhagic complications of IVtPA, and all patients were discharged home. Discharge NIHSS was 0 in most patients (82%). Conclusions: Complicated migraine presentation mimics acute ischemic stroke and made up 7.4% of the patients who received IVtPA in our telestroke system. Further studies are warranted. Disclosure: Dr. Cash has nothing to disclose. Dr. Yadav has nothing to disclose. Dr. Lakhani has nothing to disclose. Dr. Salam has nothing to disclose. Dr. wiles has nothing to disclose. Dr. Lee has nothing to disclose.