Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset.

Abstract

Background and Purpose:We sought to detect prognostic factors related to functional outcome during the first 6 hours after a first-ever stroke in the carotid artery territory.Methods: All patients with these characteristics seen during a 3-year period were included. Outcome was evaluated according to a modified Rankin scale. The following variables were examined at univariate analysis: sex, age, severity of deficit at entry and at day 7, level of consciousness at entry, time after symptom onset, history of smoking, history of hypertension, diabetes, myocardial infarction, atrial fibrillation, rheumatic heart disease, dilated cardiomyopathy, all potential cardioembolic sources, presence of a consistent lesion on computed tomography at entry and at days 5-9, and the size of such lesion.Results: All entry criteria were met by 172 patients. Age >70 years, a Canadian Neurological Scale score <6.5 at entry and at day 7, atrial fibrillation, presence of a potential cardioembolic source, and a "large" lesion (involving more than half the cerebral lobe) on computed tomography at days 5-9 were associated with a significantly worse outcome both at 30 days and at 6 months. After multivariate analysis, a Canadian Scale score <6.5 at entry (/J<0.0001) and atrial fibrillation (p=0.005) were associated with a significant handicap or death at 30 days, whereas only a Canadian Scale score <6.5 (p<0.0001) was associated with a worse prognosis at 6 months. An association of age >70 years with a worse outcome at 6 months was of borderline significance (jp=0.054).Conclusions: Some prognostic indicators are available during the first few hours after onset of a carotid ischemic stroke and may be useful in the stratification of patients in clinical trials. Severity of deficit is the most important indicator, whereas the presence of atrial fibrillation worsens the prognostic outlook with respect to early handicap but not mortality.

99m Technetium-Ethyl-Cysteinate-Dimer Single-Photon Emission CT Can Predict Fatal Ischemic Brain Edema

“…53 It was shown that parenchymal hypodensity is a reliable sign of irreversible brain tissue damage. 12,15,22,54 We could not identify clinical variables as independent predictors for early cerebral death after ischemic stroke. Censori et al 12 found among 172 patients with ischemic stroke admitted within 6 hours only a Canadian Neurological Scale score Ͻ6.5 at entry and atrial fibrillation associated with a significant handicap or death after 30 days.…”

“…Only a few studies included data from the first 6 hours after stroke onset, [12][13][14][15] and the findings are contradictory. 16,17 Many studies did not differentiate between hemorrhagic and ischemic stroke 2,18,19 or were retrospective.…”

What Determines Good Recovery in Patients With the Most Severe Strokes?

“…This confirms previous findings in the general stroke population. 3,10,[21][22][23][24] It should be emphasized that function was defined by the ability to perform basic activities of daily living as measured by the BI. An influence on the ability to perform instrumental activities of daily living or higher cognitive functions can therefore not be excluded.…”

Cardiac Baroreceptor Sensitivity Predicts Long-Term Outcome After Acute Ischemic Stroke

“…Patients were then classified as dependent if exhibiting a moderate to severe handicap (mRS Ն3) or independent with no to mild handicap (mRS Յ2). 20 Finally, mortality was recorded over a median follow-up period of 1508 days (range, 9 to 2656 days) after acute ictus. To ensure data capture as complete as possible, mortality outcome was assessed from a number of sources, including hospital medical records, hospital information systems, general practitioner records, and Health Authority returns from general practitioners and from the registrar for births, marriages, and deaths.…”