Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack. (20th October 2020)

• Record Type: Journal Article
• Authors: Park, Tai Hwan; Lee, Jeong-Kon; Park, Moo-Seok; Park, Sang-Soon; Hong, Keun-Sik; Ryu, Wi-Sun; Kim, Dong-Eog; Park, Man Seok; Choi, Kang-Ho; Kim, Joon-Tae; Kang, Jihoon; Kim, Beom Joon; Han, Moon-Ku; Lee, Jun; Cha, Jae-Kwan; Kim, Dae-Hyun; Kim, Jae Guk; Lee, Soo Joo; Cho, Yong-Jin; Kwon, Jee-Hyun; Shin, Dong-Ick; Yeo, Min-Ju; Sohn, Sung Il; Hong, Jeong-Ho; Lee, Ji Sung; Choi, Jay Chol; Kim, Wook-Joo; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Park, Jong-Moo; Kang, Kyusik; Lee, Kyung Bok; Lee, Juneyoung; Gorelick, Philip B.; Bae, Hee-Joon;
• Is Part Of: Neurology. Volume 95:Number 16(2020)
• Publication Date: 2020-10-20
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000010603
• Languages: English
• ISSNs: 0028-3878

Abstract

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.