Characteristics and Outcome of Patients with Early Complete Neurological Recovery after Thrombolysis for Acute Ischemic Stroke

Abstract

Background: Recombinant tissue plasminogen activator (rt-PA) is the only approved specific therapy for acute ischemic stroke. This study analyzes demographic and clinical characteristics of patients with early complete neurological recovery after thrombolysis. Methods: Data of 320 consecutive patients treated with rt-PA within 3 h of stroke onset at our facility between April 2006 and March 2009 were extracted from our prospective institutional stroke and thrombolysis database. Baseline demographic parameters, risk factors, clinical characteristics as well as neuroradiologic findings of patients with complete recovery 24 h after treatment and at hospital discharge were analyzed. Outcome was evaluated using the modified Rankin Scale at 90 days. Results: Thirty patients (9.4%) were asymptomatic 24 h after thrombolysis and 70 (22%) at hospital discharge. Patients with complete recovery were younger, more often male, had milder stroke symptoms, less often cardioembolic strokes, fewer bleeding complications and more often normal follow-up imaging. In addition, in-hospital time was shorter and these patients retained a better functional outcome at 90 days. Only 1 patient who had completely recovered at hospital discharge died during the follow-up time. In multivariate regression analysis, only the National Institute of Health Stroke Score (NIHSS) on admission was predictive for complete recovery at both examined time points. Conclusion: Rapid complete recovery can be achieved in up to a fifth of acute stroke patients treated with thrombolysis. These patients are younger and have milder strokes, less often with cardioembolic origin. Better outcome and lower mortality are sustained at 3 months.

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

“…In such patients, NIHSS is lower (mean 5 points), age is younger, frequency of diabetes mellitus and cardioembolism are lower (23). In 24 hours following IV tPA, dramatic improvement is observed in 25% of patients (24,25). Although it has many definitions, at least a 50% decrease in NIHSS and reduction of NIHSS below 4 points are commonly used definitions for dramatic improvement (24).…”

“…Although it has many definitions, at least a 50% decrease in NIHSS and reduction of NIHSS below 4 points are commonly used definitions for dramatic improvement (24). In half of such patients, which constitute 10-15% of all patients given IV tPA, full improvement is achieved (25). If there is no diffusion restriction in diffusion-weighted images, these patients are defined as having "aborted stroke" not "TIA" (25).…”

“…In half of such patients, which constitute 10-15% of all patients given IV tPA, full improvement is achieved (25). If there is no diffusion restriction in diffusion-weighted images, these patients are defined as having "aborted stroke" not "TIA" (25). To define a patient as having "aborted stroke", occlusion should be revealed through vascular imaging before lytic treatment.…”

“…To define a patient as having "aborted stroke", occlusion should be revealed through vascular imaging before lytic treatment. Strokemimics constitute 10% of patients who improve fully (25).…”

Prevention and treatment of ischemic stroke in patients with atrial fibrillation

“…A high-risk CHADS2 score at admission is a powerful predictor of poor neurological outcome after controlling for all possible confounders and thus an independent predictor of all causes of death during the follow-up (26). Recently, however, neurological scores at discharge sufficiently represent the final neurological outcome of patients (8).…”