RT Journal Article SR Electronic T1 Munchausen Syndrome by Tissue Plasminogen Activator JF Neurology: Clinical Practice FD Lippincott Williams & Wilkins SP 64 OP 68 DO 10.1212/CPJ.0000000000000828 VO 11 IS 1 A1 Willenberg, Rafer A1 Leung, Bo A1 Song, Shlee A1 Dumitrascu, Oana M. A1 Schlick, Konrad A1 Lyden, Patrick YR 2021 UL http://cp.neurology.org/content/11/1/64.abstract AB Purpose of Review Munchausen syndrome by tissue plasminogen activator (tPA) is a phenomenon we describe as patients exhibiting factitious symptoms to assume the role of the sick patient, desiring and received tPA, with no alternative diagnosis or secondary gain to better account for their presentation. To illustrate this phenomenon and its magnitude, we present a series of cases of Munchausen syndrome by tPA, prevalence in our stroke center, and highlight one illustrative case.Recent Findings Of 335 cases with tPA administration over 29 months, 10 were confirmed as Munchausen syndrome by tPA, reflecting a 3.0% prevalence in our stroke center.Summary Munchausen syndrome by tPA is an underappreciated phenomenon encountered in evaluating patients with acute stroke symptoms. Administering tPA in Munchausen syndrome poses an ethical dilemma because standard of care favors rapid tPA administration, but administration can cause harm, burdens the healthcare system, and does not treat the patient's Munchausen syndrome.