BACKGROUND AND PURPOSE: Our aims were to identify predictors of early neurological improvement in acute ischemic stroke patients, to evaluate its impact on clinical outcome, and to investigate possible mechanisms. METHODS: A consecutive series of 152 first-ever ischemic hemispheric stroke patients hospitalized within 5 hours of onset underwent a first CT scan within 1 hour of hospitalization, and the initial subset of 80 patients also underwent angiography. During the first 48 hours of hospital stay, an increase or a decrease of 1 or more points in the admission Canadian Neurological Scale (CNS) score was defined as early improvement or early deterioration, respectively. Repeated CT scan or autopsy was performed 5 to 9 days after stroke. RESULTS: Thirty-four patients (22%) improved, 84 (56%) remained stable, and 34 (22%) deteriorated. Logistic regression, which took into account vascular risk factors, baseline clinical and CT data, and therapies administered, selected younger age, lower admission CNS score, and absence of early hypodensity at first CT as independent predictors of early improvement. Among the patients who underwent angiography, logistic regression selected arterial patency and presence of collateral blood supply as independent predictors of early improvement. At the repeated CT scan or autopsy, improving patients presented the highest frequency of small infarcts. Thirty-day case-fatality rate and disability were lower in improving patients. Variables independently associated with outcome at logistic regression were admission CNS score, early deterioration, and early improvement. CONCLUSIONS: Early improvement can be predicted by the absence of early CT hypodensity and is highly predictive of good outcome. Presence of collateral blood supply and presumably early spontaneous recanalization are likely to be the mechanisms underlying early improvement.
BACKGROUND AND PURPOSE: Our aims were to identify predictors of early neurological improvement in acute ischemic strokepatients, to evaluate its impact on clinical outcome, and to investigate possible mechanisms. METHODS: A consecutive series of 152 first-ever ischemic hemispheric strokepatients hospitalized within 5 hours of onset underwent a first CT scan within 1 hour of hospitalization, and the initial subset of 80 patients also underwent angiography. During the first 48 hours of hospital stay, an increase or a decrease of 1 or more points in the admission Canadian Neurological Scale (CNS) score was defined as early improvement or early deterioration, respectively. Repeated CT scan or autopsy was performed 5 to 9 days after stroke. RESULTS: Thirty-four patients (22%) improved, 84 (56%) remained stable, and 34 (22%) deteriorated. Logistic regression, which took into account vascular risk factors, baseline clinical and CT data, and therapies administered, selected younger age, lower admission CNS score, and absence of early hypodensity at first CT as independent predictors of early improvement. Among the patients who underwent angiography, logistic regression selected arterial patency and presence of collateral blood supply as independent predictors of early improvement. At the repeated CT scan or autopsy, improving patients presented the highest frequency of small infarcts. Thirty-day case-fatality rate and disability were lower in improving patients. Variables independently associated with outcome at logistic regression were admission CNS score, early deterioration, and early improvement. CONCLUSIONS: Early improvement can be predicted by the absence of early CT hypodensity and is highly predictive of good outcome. Presence of collateral blood supply and presumably early spontaneous recanalization are likely to be the mechanisms underlying early improvement.
Authors: Latisha K Ali; Julius K Weng; Sidney Starkman; Jeffrey L Saver; Doojin Kim; Bruce Ovbiagele; Brian H Buck; Nerses Sanossian; Paul Vespa; Oh Young Bang; Reza Jahan; Gary R Duckwiler; Fernando Viñuela; David S Liebeskind Journal: Interv Neurol Date: 2016-09-30
Authors: John R Sims; Guy Rordorf; Eric E Smith; Walter J Koroshetz; Michael H Lev; Ferdinando Buonanno; Lee H Schwamm Journal: AJNR Am J Neuroradiol Date: 2005-02 Impact factor: 3.825
Authors: Oh Young Bang; Hee Young Park; Jung Han Yoon; Seung Hyeon Yeo; Ji Won Kim; Mi Ae Lee; Mi Hee Park; Phil Hyu Lee; In Soo Joo; Kyoon Huh Journal: J Clin Neurol Date: 2005-10-20 Impact factor: 3.077
Authors: Farhaan S Vahidy; William J Hicks; Indrani Acosta; Hen Hallevi; Hui Peng; Renganayaki Pandurengan; Nicole R Gonzales; Andrew D Barreto; Sheryl Martin-Schild; Tzu-Ching Wu; Mohammad H Rahbar; Arvind B Bambhroliya; James C Grotta; Sean I Savitz Journal: Neurology Date: 2014-06-25 Impact factor: 9.910