Ethical Challenges in Acute Evaluation of Suspected Psychogenic Stroke Mimics

• Published in: The Journal of clinical ethics Vol. 29; no. 3; p. 185
• Main Authors: Sequeira, Alexandra J, Fara, Michael G, Lewis, Ariane
• Format: Journal Article
• Language: English
• Published: United States 01.09.2018
• Subjects: Aged; Cocaine-Related Disorders - complications; Diagnosis, Differential; Ethics, Clinical; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Hemiplegia - etiology; Humans; Male; Malingering - diagnosis; Middle Aged; Sinus Thrombosis, Intracranial - complications; Somatoform Disorders - diagnosis; Stroke - diagnosis; Stroke - psychology; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects
• ISSN: 1046-7890
• DOI: 10.1086/JCE2018293185

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology.