Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke

Matsumoto, Noriko; Kimura, Kazumi; Yokota, Chiaki; Yonemura, Kensuke; Wada, Keita; Uchino, Makoto; Minematsu, Kazuo

doi:10.1016/j.jns.2003.09.003

Cited by 13 publications

(13 citation statements)

References 22 publications

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“…Different results from the report by Matsumoto et al [35] showed that neurological deterioration occurred in 6 of 46 patients within the first 7 days after stroke and 4 of them had new acute ischemic lesions. However, they included patients with other kinds of etiology, such as atrial fibrillation and aortic complicated plaque which tended to cause large wedge-shaped infarction.…”

Section: Discussioncontrasting

confidence: 63%

The Significance of Microembolic Signals and New Cerebral Infarcts on the Progression of Neurological Deficit in Acute Stroke Patients with Large Artery Stenosis

Hao¹,

Leung²,

Leung³

et al. 2010

Cerebrovasc Dis

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Background: Early neurological deterioration is common in the acute phase after stroke. We sought to investigate the correlation between the progression of microembolic signal (MES), ischemic infarcts and the neurological deficits in the acute phase of stroke patients with large artery occlusive disease. Methods: Transient ischemic attack or stroke patients with relevant significant large artery stenosis (≧50% diameter reduction) and admitted within 7 days of the symptom onset were recruited in this study. MES, infarcts on diffusion-weighted imaging and National Institutes of Health Stroke Scale (NIHSS) score were assessed on days 1 and 7 of recruitment. Results: Among 67 patients, 50.7% (34 of 67) had MES on day 1. Presence of MES correlated with both a higher number of infarcts (p = 0.006) and the incidence of multiple infarcts (χ² test, p = 0.002), but not with the NIHSS score. On day 7, MES was detected in 25.4% of the patients (17 of 67), 11.8% of them (2 of 17) displayed new or extended infarct on DWI (p = 0.14) and 29.4% (5 of 17) showed neurological improvement (p = 0.039). Among the patients with positive MES at baseline, NIHSS reduction was positively correlated with disappearance of MES on day 7 (MES disappearance vs. persistence group, 2.05 vs. 0.73, p = 0.023). Conclusions: Neither the disappearance of MES nor the changes in NIHSS score correlated with the progression of infarct. Disappearance of MES indicated better neurological improvement in the acute phase.

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Section: Discussioncontrasting

confidence: 63%

The Significance of Microembolic Signals and New Cerebral Infarcts on the Progression of Neurological Deficit in Acute Stroke Patients with Large Artery Stenosis

Hao¹,

Leung²,

Leung³

et al. 2010

Cerebrovasc Dis

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“…First at all, a new stroke may occur in the same arterial territory. In fact, very early recurrence in the same arterial territory has been strongly related to a high-grade arterial stenosis [30,31,32]. A second mechanism could be the increase in the penumbra area related to reduced hemodynamic flow, thus making neurons in this area more susceptible to other adverse clinical and biological factors such as blood pressure [33].…”

Section: Discussionmentioning

confidence: 99%

Steno-Occlusive Arterial Disease and Early Neurological Deterioration in Acute Ischemic Stroke

et al. 2008

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Aim: To evaluate the influence that steno-occlusive arterial disease may have on the development of early neurological deterioration (END) in a large series of patients with acute ischemic stroke. Methods: We studied a prospective cohort of 1,093 patients admitted to a single tertiary hospital with presence of neurological symptoms in the first 24 h after stroke onset. END was defined as any increase in the National Institutes of Health Stroke Scale score ≧4 points in the first 72 h. The arterial study assessed the presence of arterial occlusion or significative stenosis in the symptomatic territory. Additionally, age, initial stroke severity, blood pressure, glucose levels, vascular risk factors, lacunar stroke and prior use of antithrombotic treatment were also analyzed in a multivariable analysis. Results: END was detected in 179 patients (16.3%). Steno-occlusive disease (adjusted OR 3.60), initial blood pressure and abdominal obesity were independently associated with END. Both arterial stenosis (adjusted OR 2.33) or occlusions (adjusted OR 3.65) were associated with END. The higher adjusted OR (5.49) was obtained for steno-occlusive arterial disease in the vertebrobasilar system. Conclusions: An early arterial study may provide key data for the selection of patients with higher risk of END after acute ischemic stroke.

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“…In most cases this fact clearly represents a recurrent event; in lacunar strokes with only 1 acute lesion, however, the concrete pathophysiology of deterioration is unclear. [32][33] Our methodology could, therefore, have overestimated the recurrence rate. Nevertheless, we chose this definition in spite of the clinical interest in identifying all events that represent a poor neurological evolution.…”

Section: Limitationsmentioning

confidence: 98%

Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

Ois

Gomis

Rodríguez-Campello

et al. 2008

Stroke

143

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Background and Purpose-The aim of our study was to identify factors associated with stroke recurrence after an initial minor stroke or transient ischemic attack (TIA) in a prospective hospital-series. Methods-Included in the series were 689 patients with NIHSS lower than 4 at hospital admission. The end point was a new neurological event (worsening Ն4 points in the initial NIHSS was considered as recurrence) at 90 days (and additionally at 7 days). Factors based on two previous reported scores (ABCD and SPI-II) were analyzed in relation with stroke recurrence: age, duration of symptoms Ͼ1 hour, weakness, speech impairment, initial hypertension, hypertension, diabetes, coronary disease, minor stroke versus TIA, prior stroke, and heart failure. We also analyzed: gender, hyperlipidemia, severe alcohol intake (Ͼ60gr/d), current smoking habits, peripheral arterial disease, atrial fibrillation, acute lesion in initial head computed tomography, severe symptomatic extra or intracranial arterial disease (SSAD; arterial stenosis Ն70%), previous TIA, and vertebrobasilar event. Patients were also analyzed separately according to diagnosis of TIA or minor stroke. Results-90-day recurrence occurred in 111 patients (16.1%), whereas 62 patients had 7-day recurrence (9%). The independent variables associated with 90-day recurrence were: SSAD (ORϭ4.97), weakness (ORϭ3.25), speech impairment (ORϭ1.96), severe alcohol intake (ORϭ4.18), heart failure (ORϭ2.41), previous TIA (ORϭ4.62), and vertebrobasilar events (ORϭ2.87). SSAD was independently associated with 7-day recurrence (ORϭ7.73) and also for TIA (ORϭ3.45) and minor stroke (ORϭ5.15) patients. Conclusions-An arterial study to discard SSAD would be necessary, in combination with clinical factors, to improve the identification of patients with a higher risk of 90-day recurrence after an initial minor stroke or TIA.

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Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke

Cited by 13 publications

References 22 publications

The Significance of Microembolic Signals and New Cerebral Infarcts on the Progression of Neurological Deficit in Acute Stroke Patients with Large Artery Stenosis

The Significance of Microembolic Signals and New Cerebral Infarcts on the Progression of Neurological Deficit in Acute Stroke Patients with Large Artery Stenosis

Steno-Occlusive Arterial Disease and Early Neurological Deterioration in Acute Ischemic Stroke

Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

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