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 (ORadj) 0.92), had a higher incidence of psychiatric disorders (ORadj 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 (ORadj = 9.28) and sensory deficits (ORadj = 3.87), and less visual field defects (ORadj = 0.14) and dysarthria (ORadj = 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- scorematched analysis, and lower mortality (0% vs. 20%, padj 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.
Loading....