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Factors associated with migraine aura mimicking stroke in code stroke

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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)).

Author information

Authors and Affiliations

  1. Neurology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain

    Adrià Macias-Gómez, Antoni Suárez-Pérez, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Antía Moreira, Daniel Guisado-Alonso, Isabel Fernández-Pérez, Jordi Jiménez-Conde, Jaume Roquer, Ángel Ois & Elisa Cuadrado-Godia

  2. Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain

    Adrià Macias-Gómez, Antoni Suárez-Pérez, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Isabel Fernández-Pérez, Jordi Jiménez-Conde, Lucía Rey, Joan Jiménez-Balado, Jaume Roquer, Ángel Ois & Elisa Cuadrado-Godia

  3. Neuroradiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain

    Jaume Capellades

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  1. Adrià Macias-Gómez
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Contributions

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.

Corresponding author

Correspondence to Eva Giralt-Steinhauer.

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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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