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

Neurology

From the Department of Neurology (T.H.P., M.-S.P., S.-S.P.), Seoul Medical Center; Department of Neurology, Cerebrovascular Center (J.-K.L., J.K., B.J.K., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (W.-S.R., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Department of Neurology (M.S.P., K.-H.C., J.-T.K.), Chonnam National University Hospital, Gwangju; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K.), Dong-A University Hospital, Busan; Department of Neurology (J.G.K., S.J.L.), Eulji University Hospital, Eulji University, Daejeon; Department of Neurology (J.-H.K., W.-J.K.), Ulsan University College of Medicine; Department of Neurology (D.-I.S., M.-J.Y.), Chungbuk National University Hospital, Cheongju; Department of Neurology (S.I.S., J.-H.H.), Keimyung University Dongsan Medical Center, Daegu; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Neurology (J.C.C.), Jeju National University Hospital, Jeju National University School of Medicine; Department of Neurology (B.-C.L., K.-H.Y., M.-S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.-M.P., K.K.), Eulji General Hospital, Eulji University, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul; and Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Davee, Chicago, IL.

Published: October 2020

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.

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http://dx.doi.org/10.1212/WNL.0000000000010603	DOI Listing

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