Abstract
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.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
We would like to thank Álvaro Villarino for his contribution to language edition of the manuscript.
Funding
This work was supported in part by Spain’s Ministry of Health (Instituto de Salud Carlos III, Fondos FEDER, RICORS-ICTUS (RD21/0006/0021)).
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AMG and ECG were involved in the conception and design of the study, interpretation of data, and in the writing of the manuscript. AMG and ASP contributed to data acquisition. ECG, AO, and JJB performed the statistical analysis. All authors interpreted the data, reviewed the manuscript, and approved the final version.
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Macias-Gómez, A., Suárez-Pérez, A., Rodríguez-Campello, A. et al. Factors associated with migraine aura mimicking stroke in code stroke. Neurol Sci 44, 2113–2120 (2023). https://doi.org/10.1007/s10072-023-06641-y
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DOI: https://doi.org/10.1007/s10072-023-06641-y