Early neurological deterioration in acute ischemic stroke

Çeli̇k, Oğuzhan; Çil, Cem; Biteker, Funda Sungur; Gökçek, Aysel; Doğan, Volkan

doi:10.1097/jcma.0000000000000022

Cited by 6 publications

(8 citation statements)

References 6 publications

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“…It is reported that END observed in the acute phase of the stroke and usually leading to an unexpectedly severe disability status, is not rare in acute stroke patients. [19][20][21] Until now, the pathophysiology under…”

Section: Discussionmentioning

confidence: 99%

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Duan

Tao

Yang

et al. 2020

J of Clinical Hypertension

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It is generally known that acute minor stroke and transient ischemic attack (TIA) seem to be benign. However, their occurrence in patients with steno‐occlusive arterial disease may result in early neurological deterioration (END). We aimed to elucidate the effect of blood pressure variability (BPV) on the development of END. Consecutive acute minor stroke and TIA patients within 24 hours of onset were prospectively recruited from the Affiliated Hospital of Yangzhou University between Aug 2015 and Feb 2019. END was defined as an NIHSS score increased ≥1 during the first 72 hours compared with the initial NIHSS score. During this period, the mean, maximum (max), the difference between the maximum and minimum (max‐min), the SD, and coefficient of variation of BP (BPCV) were calculated. Of the 160 total patients enrolled in the study (mean age, 68.01 ± 9.33 years; 50.6% female), 52 (32.5%) patients occurred END during the first 72h after admission. To express the BPV as a categorical variable, we classified the subjects into one of four groups, representing four quartiles of BPV. In the multivariable analyses, the lowest quartiles were considered as reference groups. The results showed that patients who fell in the fourth quartile (SBPmax‐min:OR = 3.289, 95% CI 1.147‐9.430; SBPSD:OR = 3.313, 95% CI 1.041‐10.547; SBPCV:OR = 3.425, 95% CI 1.164‐10.077; DBPSD:OR = 3.124, 95% CI 1.065‐9.158) had a significantly higher risk of END after adjusting the variables (age, female, diabetes mellitus, atrial fibrillation, and CRP with P values <.1 in univariate analyses). Our study demonstrated that the acute in‐hospital BPV was associated with the development of END in acute minor stroke and TIA with steno‐occlusive arterial disease.

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Section: Discussionmentioning

confidence: 99%

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Duan

Tao

Yang

et al. 2020

J of Clinical Hypertension

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“…Early neurological deterioration is usually defined as clinical deterioration or recurrence within 72 h after an ischemic stroke ( 16 ). For this study, END was defined as a National Institutes of Health Stroke Scale (NIHSS) score of more than 2 points recorded within 72 h after admission ( 17 , 18 ).…”

Section: Methodsmentioning

confidence: 99%

The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients

Huang¹,

Liu

Yun

et al. 2022

Front. Neurol.

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Background and purposeAsymmetrical prominent veins sign (APVS) often appears on susceptibility-weighted angiography (SWAN) images in patients with acute stroke. Early neurological deterioration (END) is highly correlated with survival prognosis in patients with ischemic stroke. This study sought to explore the relationship between APVS and END in patients with acute stroke.MethodsThe subjects retrospectively enrolled in this study were patients with acute ischemic stroke in the middle cerebral artery supply area. All patients underwent head MRI, including the SWAN sequence, within 7 days of stroke symptom onset. END was defined as clinical deterioration or recurrence within 72 h after ischemic stroke. The volume of infarction on diffusion-weighted imaging was measured. Univariate and multivariate analyses were used to analyze the relationship between APVS and END. Spearman correlation between APVS grades and infarct volume, white matter hyperintensity (WMH) volume, and offending vessel were also analyzed.ResultsA total of 157 patients with middle cerebral artery infarct between September 2018 and April 2020 were included in the study. APVS appeared on MRI in 84 of 157 patients, and 34 of 157 patients were diagnosed with END. In patients with END, the proportion of severe APVS was higher than in patients without END (P = 0.001, x2 = 14.659). Patients with END were older and had a larger volume of infarct and WMH than patients without END (all P < 0.05). After adjustments were made for related risk factors of END, the severity of APVS was still related to END (OR = 2.56, 95% CI, 1.38–4.75; P for trend = 0.003). Spearman correlation showed that APVS grades were positively related to infarct volume (r = 0.289, P < 0.001) and 3-month modified Rankin Scale score (r = 0.203, P = 0.011) and negatively related to offending vessels (r = −0.170, P = 0.034).ConclusionAPVS may be an important predictor of END in patients with acute ischemic stroke.

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“…However, the disease mechanism and risk factors for END remained unknown. Existing evidence suggested the mechanism might be related to new infarcts, hemorrhagic transformation, encephaledema, and onset of seizure [4,6]. Furthermore, in AIS patients with large vessel occlusion suitable for MT therapy, the reperfusion rate for intravenous thrombolysis was about 10% [7].…”

Section: Introductionmentioning

confidence: 99%

“…Early neurological deterioration (END) is defined as an increase of two points or more in the NIHSS score or a presence of any novel neurological damage compared with NIHSS score assessed at the best neurological status during the in-hospital period, however, the time range remains unsettled. 1,2 END in patients with AIS accounts for the incidence ranging from 10 to 40% (before the era of mechanical thrombectomy [MT]), [3][4][5] and can lead to poor clinical outcomes as well as life quality of the patients. However, the disease mechanism and risk factors for END remained unknown.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Functional Outcomes with Early Neurological Deterioration after Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke

Liu

Zhang

Hai-xia

et al. 2022

J Neurol Surg B Skull Base

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Early neurologic deterioration (END) is associated with a poor survival after mechanical thrombectomy (MT) in acute ischemic stroke (AIS). To assess risk factors and functional outcomes of END after MT in patients. We retrospectively analyzed data from 79 patients who received MT with large-vessel occlusion. The definition of END after MT in patients was that the National Institute of Health Stroke Scale (NIHSS) score increased by 2 or more points, compared with the best neurological status within 7 days. The mechanism of END can be classified into: AIS progression, sICH and encephaledema. A total of 32 AIS patients (40.5%) had END after MT. Risk factors for END after MT included: history of oral antiplatelet and/or anticoagulation drugs before MT (OR=9.56,95%CI=1.02~89.57), higher NIHSS score when admitted to hospital (OR=1.24,95%CI=1.04~1.48), under the subtype of atherosclerotic stroke (OR=17.36,95%CI=1.51~199.56), ASITN/SIR<2 (OR=15.78, 95%CI=1.65~151.26), and prolonged period from AIS onset to the first revascularization (OR=1.01, 95%CI=1.00~1.02). AIS patients who had END at early stages were more likely to experience poor outcomes (mRS>2) at 90 days after MT (OR=6.829,95%CI=1.573~29.655). Conclusion: AIS patients who had experienced END at early stages were more likely to have poor outcomes (mRS>2) at 90 days after MT, and the risk factors of END were connected with the mechanism of END.

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Early neurological deterioration in acute ischemic stroke

Cited by 6 publications

References 6 publications

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

The role of asymmetrical prominent veins sign in early neurological deterioration of acute ischemic stroke patients

Risk Factors and Functional Outcomes with Early Neurological Deterioration after Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke

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