Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack.

Abstract

OBJECTIVE:

To improve epidemiologic knowledge of neurologic deterioration (ND) in patients with acute ischemic stroke (AIS).

METHODS:

In this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.

RESULTS:

ND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3-6) at 3 months and 1 year were 1.75 (1.70-1.80) and 1.70 (1.65-1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45-1.74).

CONCLUSIONS:

ND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.

• Authors: Tai Hwan Park, Jeong-Kon Lee, Moo-Seok Park, Sang-Soon Park, Keun-Sik Hong, Wi-Sun Ryu, Dong-Eog Kim, Man Seok Park, Kang-Ho Choi, Joon-Tae Kim, Jihoon Kang, Beom Joon Kim, Moon-Ku Han, Jun Lee, Jae-Kwan Cha, Dae-Hyun Kim, Jae Guk Kim, Soo Joo Lee, Yong-Jin Cho, Jee-Hyun Kwon, Dong-Ick Shin, Min-Ju Yeo, Sung Il Sohn, Jeong-Ho Hong, Ji Sung Lee, Jay Chol Choi, Wook-Joo Kim, Byung-Chul Lee, Kyung-Ho Yu, Mi-Sun Oh, Jong-Moo Park, Kyusik Kang, Kyung Bok Lee, Juneyoung Lee, Philip B Gorelick, Hee-Joon Bae
• Journal: Neurology (Neurology) Vol. 95 Issue 16 Pg. e2178-e2191 (10 20 2020) ISSN: 1526-632X [Electronic] United States
• PMID: 32817184 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 American Academy of Neurology.

Topics

• Aged
• Brain Ischemia (epidemiology)
• Female
• Humans
• Ischemic Attack, Transient (epidemiology)
• Male
• Middle Aged
• Nervous System Diseases (epidemiology)
• Prospective Studies
• Risk Factors
• Stroke (epidemiology)
• Time Factors