Neurofluctuation in patients with subcortical ischemic stroke.
Publication/Presentation Date
7-29-2014
Abstract
OBJECTIVE: The purpose of this study was to assess the incidence of deterioration, fluctuation, and associated risk of poor outcome in patients with subcortical stroke (SCS).
METHODS: We conducted a prospective observational study, enrolling patients admitted with SCS based on their clinical examination and imaging studies. An NIH Stroke Scale evaluation was performed daily and whenever deterioration in examination was detected. Neurologic deterioration was defined as a motor score increase of at least 1 on the NIH Stroke Scale. Modified Rankin Scale scores at discharge were used to assess outcome.
RESULTS: Among 90 enrolled patients, 37 (41%) deteriorated, 75% of them in the first 24 hours after enrollment. Administration of tissue plasminogen activator was significantly associated with deterioration (hazard ratio 2.25; 95% confidence interval [CI]: 1.13-4.49) even after controlling for the association of deterioration with the early poststroke period. Deterioration conferred an increased risk of poor outcome (modified Rankin Scale scores 3-6) at discharge (relative risk: 1.80; 95% CI: 1.71-1.93). Reversion back to predeterioration deficits occurred in 38% of patients, and was associated with reduced risk of poor outcome at discharge (relative risk: 0.12; 95% CI: 0.02-0.83). Treatment with tissue plasminogen activator conferred better chances of spontaneous recovery to predeterioration deficits after initial deterioration (hazard ratio: 4.36; 95% CI: 1.36-14.01).
CONCLUSION: More than 40% of patients with SCS deteriorate neurologically. Deterioration tends to occur early after stroke, spontaneously reverses in approximately one-third of cases, and poses an increased risk of poor outcome. Therapies are needed to prevent, arrest, or reverse deterioration in patients with SCS.
Volume
83
Issue
5
First Page
398
Last Page
405
ISSN
1526-632X
Published In/Presented At
Vahidy, F. S., Hicks, W. J., 2nd, Acosta, I., Hallevi, H., Peng, H., Pandurengan, R., Gonzales, N. R., Barreto, A. D., Martin-Schild, S., Wu, T. C., Rahbar, M. H., Bambhroliya, A. B., Grotta, J. C., & Savitz, S. I. (2014). Neurofluctuation in patients with subcortical ischemic stroke. Neurology, 83(5), 398–405. https://doi.org/10.1212/WNL.0000000000000643
Disciplines
Medicine and Health Sciences
PubMedID
24966405
Department(s)
Department of Medicine
Document Type
Article