Abstract:

Objective

To investigate the clinical and imaging characteristics of microcerebral hemorrhage cases misdiagnosed as acute minor stroke， thereby offering guidance for the administration of intravenous thrombolysis in minor stroke patients.

Methods

This retrospective cohort study included 194 patients with ischemic stroke who received intravenous thrombolysis with Alteplase at Beijing Chaoyang Hospital and affiliated hospitals from January 1 to December 31， 2023. It retrospectively analyzed the microcerebral hemorrhage cases that were misdiagnosed as minor stroke and underwent intravenous thrombolysis or nearly underwent thrombolysis.

Results

Among 194 patients， 89 were diagnosed with minor stroke， including 2 patients with microcerebral hemorrhage who were misdiagnosed as minor stroke and treated with intravenous thrombolysis or nearly treated with thrombolysis. These cases comprised thalamic microcerebral hemorrhage， and a small amount of subdural hemorrhage， respectively.

Conclusion

Patients with microcerebral hemorrhage exhibited relatively mild clinical symptoms， showing only mild lateral or limb numbness， without headache， dizziness， nausea and vomiting， and impaired consciousness， which are common in cerebral hemorrhage. Cranial CT scans were often unclear， rendering them susceptible to underdiagnosis or misdiagnosis of minor ischemic stroke. Therefore， it is crucial to accurately identify microcerebral hemorrhage in patients with minor stroke who are ready for intravenous thrombolysis.

Key words: Minor stroke, Thrombolytic therapy, Alteplase, Microcerebral hemorrhage, Misdiagnosis