Factors associated with migraine aura mimicking stroke in code stroke

• Published in: Neurological sciences Vol. 44; no. 6; pp. 2113 - 2120
• Main Authors: Macias-Gómez, Adrià, Suárez-Pérez, Antoni, Rodríguez-Campello, Ana, Giralt-Steinhauer, Eva, Moreira, Antía, Guisado-Alonso, Daniel, Capellades, Jaume, Fernández-Pérez, Isabel, Jiménez-Conde, Jordi, Rey, Lucía, Jiménez-Balado, Joan, Roquer, Jaume, Ois, Ángel, Cuadrado-Godia, Elisa
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2023; Springer Nature B.V
• Subjects: Age; Diagnosis; Female; Fibrinogen; Fibrinolysis; Headache; Humans; Ischemia; Ischemic Stroke - complications; Male; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - complications; Migraine with Aura - epidemiology; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Psychiatry; Retrospective Studies; Risk Factors; Sex; Stroke; Stroke - complications; Stroke - diagnosis; Stroke - epidemiology; Migraine aura; Stroke; Code stroke; CT perfusion; Mimic
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-023-06641-y

Introduction Migraine with aura (MA) is a frequent stroke simulator that can lead to erroneous diagnosis and subsequent unnecessary acute or secondary prevention treatments. We analyzed clinical and laboratory data of migraine with aura and ischemic stroke patients to detect differences that could help in the diagnosis. Methods Retrospective analysis of a consecutive register of code strokes between January 2005 and June 2020. Diagnosis of ischemic stroke or MA was collected. Multivariable logistic regression analyses were performed to test associations between clinical and blood data with ischemic stroke. Results Of 3140 code strokes, 2424 (77.2%) were ischemic strokes and 34 (1.1%) were MA. Migraine cases were younger, more frequently females and with lower prevalence of vascular risk factors. Initial NIHSS was lower in MA cases, but no differences were seen in fibrinolysis rate (30%). Blood test showed lower levels of glucose, D-dimer, and fibrinogen in MA cases. Multivariable model showed and independent association for ischemic stroke with age [OR, (95%CI): 1.09, (1.07–1.12, p  < 0.001], male sex [OR, (95%CI): 4.47, (3.80–5.13), p  < 0.001], initial NIHSS [OR, (95%CI): 1.21, (1.07–1.34), p  < 0.01], and fibrinogen levels [OR, (95%CI): 1.01, (1.00–1.01), p  < 0.05]. A model including sex male OR: 3.55 [2.882; 4.598], p  < 0.001, and cutoff points (age > 65, OR: 7.953 [7.256; 8.649], p  < 0.001, NIHSS > 6, OR: 3.740 [2.882; 4.598], p  < 0.01, and fibrinogen > 400 mg/dL, OR: 2.988 [2.290; 3.686], p  < 0.01) showed a good global discrimination capability AUC = 0.89 (95%CI: 0.88–0.94). Conclusions In code stroke, a model including age, sex, NIHSS, and fibrinogen showed a good discrimination capability to differentiate between MA and Ischemic stroke. Whether these variables can be implemented in a diagnostic rule should be tested in future studies.