Thrombolysis Alert in Hassan II University Teaching Hospital of Fez (Morocco): A Prospective Study of 2 Years Moussa Toudou Daouda, MD,* Siham Bouchal, MD,* Naima Chtaou, PhD,* , † Aouatef Midaoui, PhD,* , † Zouahyr Souirti, PhD,* , ‡ , § and Faouzi Belahsen, PhD* , † Background: Thrombolysis alert (TA) is a procedure triggered every time a patient consults for sudden focal neurological deficit within 4.5 hours. Objective: We aimed to determine firstly the etiological profile of TA and secondly to evaluate the delays in the management not only of thrombolyzed patients but also of nonthrombolyzed patients to determine the intrahospital delays to optimize. Methods: Patients aged over 18 years who consulted for sudden focal neurological deficit within 4.5 hours for whom a TA has been triggered were included. Patients admitted within 4.5 hours for which a TA has not been triggered were not included. Patients with sudden focal neurological deficit who consulted more than 4.5 hours, but for whom TA has been triggered, were also included. Results: We included 313 patients. The average onset-to-door time was 125.59 ± 62.78 minutes with an average National Institutes of Health Stroke Scale scores of 11.29 ± 5.98. The average door-to- imaging time was 28.36 ± 20.62 minutes. Ischemic stroke (IS) was the most common cause (70.3%), followed by hemorrhagic stroke (11.8%). Other nonstroke causes (stroke mimics) represented 17.9% of cases. They were seizures (46.4%), conver- sion disorders (26.8%), hypoglycemia (10.7%), brain tumors (10.7%), chronic subdural hematoma (1.8%), carbon monoxide intoxication (1.8%), and cavernoma (1.8%). Forty-six patients had been thrombolyzed. The average door-to-needle time was 90.89 ± 34.48 minutes. After 3 months, 52.1% of thrombolyzed patients were au- tonomous (modified Rankin scale between 0 and 2). Two patients had died (4.3%), all in the first week after the IS. Conclusion: Our study shows that efforts need to be made at the extra-hospital and intra-hospital level to improve delays to in- crease the proportion of the thrombolyzed patients. Key Words: Neurological deficit—cerebral imaging—stroke—stroke mimics. © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. From the *Department of Neurology, Hassan II University Teaching Hospital, Fez, Morocco; †Laboratory of Epidemiology, Clinical Re- search, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed BenAbdallah University, Fez, Morocco; ‡Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco; and §Sleep Medicine Center, Hassan II University Teaching Hospital, Fez, Morocco. Received July 28, 2017; revision received November 5, 2017; accepted November 18, 2017. Grant support: This study did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. Conflict of interest: The authors declare that they have no conflicts of interest related to this article. Address correspondence to Moussa Toudou Daouda, MD, Department of Neurology, Hassan II University Teaching Hospital, Sidi Harazem Road, PO Box 1835, Atlas, Fez, Morocco. E-mail: moussatoudou@gmail.com 1052-3057/$ - see front matter © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.11.022 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2017: pp ■■–■■ 1