Time to Neurological Deterioration in Ischemic Stroke

Siegler, James E.; Albright, Karen C.; George, Alexander; Boehme, Amelia K; Gillette, Michael A.; Kumar, Andre; Aswani, Monica S.; Martin‐Schild, Sheryl

doi:10.15404/msrj/03.2016.0005

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…In the present study, we defined ND as an increase of ≥2 points in the NIHSS score within 72 h of AIS occurrence, which is caused by ischemic area extension, recurrent stroke, or symptomatic intracerebral hemorrhagic transformation. This definition is similar to that of nonreversible ND reported by Siegler et al [31]. A large infarct area with brain edema and subsequent herniation during AIS was not considered an indicator of early ND in the present study.…”

Section: Discussionsupporting

confidence: 78%

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

Chen,

Chang,

Hsiao

et al. 2024

Biomedicines

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We investigated the seasonal variations in stroke in 4040 retrospectively enrolled patients with acute ischemic stroke (AIS) admitted between January 2011 and December 2022, particularly those with cardioembolic (CE) stroke, and compared predictors of unfavorable outcomes between AIS patients and CE stroke patients. The classification of stroke subtypes was based on the Trial of ORG 10172 in Acute Stroke Treatment. Stroke occurrence was stratified by seasons and weekdays or holidays. Of all AIS cases, 18% were of CE stroke. Of all five ischemic stroke subtypes, CE stroke patients were the oldest; received the most thrombolysis and thrombectomy; had the highest initial National Institutes of Stroke Scale (NIHSS) and discharge modified Rankin Scale (mRS) scores; and had the highest rate of in-hospital complications, unfavorable outcomes (mRS > 2), and mortality. The highest CE stroke prevalence was noted in patients aged ≥ 85 years (30.9%); moreover, CE stroke prevalence increased from 14.9% in summer to 23.0% in winter. The main predictors of death in patients with CE stroke were age > 86 years, heart rate > 79 beats/min, initial NIHSS score > 16, neutrophil-to-lymphocyte ratio (NLR) > 6.4, glucose > 159 mg/dL, cancer history, in-hospital complications, and neurological deterioration (ND). The three most dominant factors influencing death, noted in not only patients with AIS but also those with CE stroke, are high initial NIHSS score, ND, and high NLR. We selected the most significant factors to establish nomograms for predicting fatal outcomes. Effective heart rhythm monitoring, particularly in older patients and during winter, may help develop stroke prevention strategies and facilitate early AF detection.

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Section: Discussionsupporting

confidence: 78%

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

Chen,

Chang,

Hsiao

et al. 2024

Biomedicines

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“…The key links in the pathogenesis of cerebral ischemia are: lack of oxygenation of neurons, oppression of the aerobic and anaerobic pathways of glucose utilization in the brain, reduced energy production, violation of the transport of potentialdetermining ions, changes in the acid-base state, excitotoxicity, the occurrence of oxidative including nitrosative stress, involved nitric oxide (NO), activation of the inflammatory process, apoptosis. These processes cannot be modeled in vitro, and most research on ischemic brain injury are conducted on animals [2]. An analysis of literature data has revealed a wide range of different methods for modeling cerebral ischemia, which makes it possible to use methods that correspond the pursued goal and technical capabilities.…”

Section: Introductionmentioning

confidence: 99%

Methods of Simulating the Pathology of the Nervous System Experimentally

Максимович¹,

Bon²,

Мороз³

2023

JCRCT

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Appropriate models of cerebral pathology contribute to detailed representations of the pathogenesis of these disorders and, in addition, allow to assess the development of damage and adaptive mechanisms of the brain, which serves as a fundamental basis for improving the methods of their diagnosis, treatment, and prevention. The data presented in the article can serve as a fundamental basis for further study of the brain in normal and pathological conditions with further extrapolation of the obtained data to humans.

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“…Existing evidence suggested that the mechanism might be related to new infarcts, hemorrhagic transformation, encephaledema, and onset of seizure. 4 6…”

Section: Introductionmentioning

confidence: 99%

“…Existing evidence suggested that 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 (IVT) was approximately 10%. 7 Therefore, in countries like the United States of America and China, MT is the therapy of choice for stroke patients with large artery occlusion.…”

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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Time to Neurological Deterioration in Ischemic Stroke

Abstract: Background-Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke. The timing of ND with respect to ND etiology and reversibility has not been investigated.

Cited by 6 publications

References 27 publications

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

Seasonal Variations in Stroke and a Comparison of the Predictors of Unfavorable Outcomes among Patients with Acute Ischemic Stroke and Cardioembolic Stroke

Methods of Simulating the Pathology of the Nervous System Experimentally

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

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