Defining Mild Stroke: Outcomes Analysis of Treated and Untreated Mild Stroke Patients

Abstract

Introduction Mild deficit is a relative contraindication to administration of IV rtPA for acute ischemic stroke. However, what constitutes “mild” deficit is vague. Prior studies showed patients with mild strokes have substantial disability rates at hospital discharge and at 90 days. We investigated whether the application of a new definition altered the rates of disability overall, and assessed the effects of thrombolysis. Methods This analysis included all adult acute ischemic stroke patients from a prospective registry of consecutive patients (UCSD SPOTRIAS database, 2003-2014) with 90-day mRS score available who were defined as “mild” using either: NIHSS 0-5 or a TREAT Task Force definition (NIHSS 0-5 and non-disabling based on pre-specified syndromes). Dichotomized 90-day mRS were compared between treated and untreated patients using the two definitions. Results Of 802 ischemic stroke patients with mRS scores available, 184 had baseline mRS(0) and met TREAT criteria; 45(24.5%) were rtPA-treated. Among treated patients, 35.6% had 90-day mRS(2-6), versus 28.8% in the untreated group, a non-significant difference after adjusting for baseline NIHSS (p=0.47). None of the 45 treated patients had symptomatic hemorrhage. Outcomes were similar using the simpler NIHSS 0-5 definition. Conclusions About one-third of mild stroke patients were not functionally independent at 90 days, irrespective of treatment or mild definition applied, calling into question the treatment efficacy of IV rtPA for mild strokes as well as what constitutes an appropriate definition of “mild”. Randomized studies are necessary to determine rtPA treatment efficacy in mild stroke patients.

Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol

“…Minor stroke is defined as 0–5 score at the NIHSS during hospitalization and at hospital discharge (Adams et al, 1999; Fischer et al, 2010; Spokoyny et al, 2015). …”

Utility of Computed Tomographic Perfusion in Thrombolysis for Minor Stroke

“…Despite mild neurological symptoms, an intra-arterial occlusion is evident on computerized tomographic angiogram (CTA) in 10% to 54% of MIS patients, and 30% have persistent disability at 90 days. [1][2][3] Mild clinical deficits with low National Institutes of Health Stroke Scale (NIHSS) scores remain a frequent reason for IV-tPA exclusion. This represents a missed opportunity to administer an effective therapy to an at-risk population.…”

Delayed Intravenous Thrombolysis in Patients with Minor Stroke

“…While only 4.6% of patients in a National Institutes of Neurological Disorders and Stroke trial had an NIHSS score < 5, the ratio of minor stroke in a recent study using the Get With The Guidelines-Stroke data was 22.4 and 26.1% of patients had a minor stroke (NIHSS score < 5) in the present study [14]. Moreover, the possibility of stroke-related disability is relatively common, even in patients with minor stroke [15,16]. Importantly, IVT has similar benefits in patients with minor stroke and those with non-minor stroke [1,17].…”