Searching for prognostic variables for secondary worsening after ischaemic stroke

Abstract

Secondary worsening of stroke symptoms is described in 13-37% of stroke patients, but the exact mechanism of this phenomenon remains unclear. The aim of this study is to find prognostic variables in correlation to secondary worsening of stroke symptoms in patients with lacunar or cortical strokes. In this prospective observational study we included all patients with ischaemic stroke; patients with transient ischaemic attack were excluded. Patients undergoing thrombolysis and becoming symptom-free after 24 h were still included in our analyses. Secondary worsening of stroke symptoms was defined as an increase of two or more points on the NIH Stroke Scale (NIHSS). The NIHSS score was assessed on admission, at discharge, and when patients had symptoms that indicated worsening of stroke. Applying univariate and multivariable analysis, we studied the relation between symptoms indicating secondary worsening of stroke and prognostic variables such as extreme nocturnal blood pressure falls (>20% of the average blood pressure), infection, diabetes mellitus, hypertension, smoking, dyslipidaemia, a history of cardiovascular or cerebrovascular disease and thrombolysis. This study included 202 patients with a mean age of 72 years, 48.8% were men and 43% had a lacunar stroke. Secondary worsening of stroke symptoms occurred in 13.5% of all patients, more often but not significantly (NS) after lacunar than cortical strokes (16.8 and 11.4%, respectively), and in patients with extreme nocturnal blood pressure falls versus without (15.6 and 11.8%, respectively (NS)). There was no significant relation between the analysed prognostic variables and secondary worsening of stroke symptoms. This study did not show significant correlation between several variables and secondary worsening of stroke symptoms in patients with recent ischaemic stroke.

Nicotine aggravates the brain postischemic inflammatory response

“…There is a dose-response relationship between cigarette consumption and stroke risk, whereas smoking cessation leads to a prompt stroke risk reduction (33). Chronic exposure to tobacco or nicotine, a major active component of cigarettes, can cause cerebral vasoconstriction, decrease cerebral blood flow (CBF) and enhance ischemic brain injury following transient middle cerebral artery occlusion (MCAO) in rats (13,38).…”

Early Neurologic Deterioration in Lacunar Stroke

“…3,4 Research in patients with lacunar strokes in the acute setting has been hampered because CT imaging and clinical scores lacked diagnostic accuracy. [5][6][7][8][9][10] Recently, new definitions were agreed on, with MRI as the gold standard, allowing more targeted research in this field. 11 The exact rate of END and whether it translates into poor long-term outcome have not been extensively studied in large cohorts of patients with advanced imaging-based diagnosis of lacunar stroke.…”

“…Research in patients with lacunar strokes in the acute setting has been hampered because CT imaging and clinical scores lacked diagnostic accuracy. 5-10 Recently, new definitions were agreed on, with MRI as the gold standard, allowing more targeted research in this field. 11…”

Avances en la fisiopatología y el tratamiento de las infecciones en la fase aguda del ictus

“…puntuació n en la escala de Rankin modificada [ERm] 2) a corto y medio plazo (< 30 días y un añ o, respectivamente) en numerosos trabajos. Estos sugieren, ademá s, que es un determinante de dicha evolució n independientemente de la estrategia terapé utica utilizada 7-10 , aunque en este caso los datos de la bibliografía no son uná nimes 11 . A pesar de haber sido objeto de investigaciones exhaustivas, todavía no se conocen con exactitud los mecanismos por los cuales el ictus favorece el desarrollo de infecciones y estas empeoran su pronó stico.…”