Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome.

Vynckier, Jan; Maamari, Basel; Grunder, Lorenz Nicolas; Goeldlin, Martina Béatrice; Meinel, Thomas Raphael; Kaesmacher, Johannes; Hakim, Arsany; Arnold, Marcel; Gralla, Jan; Seiffge, David Julian; Fischer, Urs (2021). Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. (In Press). Neurology American Academy of Neurology 10.1212/WNL.0000000000012661

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OBJECTIVE

To determine the rate and predictors of early neurological deterioration (END) in patients with lacunar strokes as well as its implications for management and outcome.

METHODS

We enrolled consecutive patients with MRI-defined lacunar stroke who presented within 12 hours after symptom onset from a prospective stroke database (2015-2019). END was defined as any persisting increase in National Institutes of Health Stroke Scale (NIHSS) score of ≥2 points within 24 hours after admission and favorable outcome as modified Rankin Scale (mRS) of 0-2 at 90 days. We assessed the association of END with clinical and imaging variables, acute treatment and outcome using multivariable regression, calculating adjusted odds ratios.

RESULTS

Sixty-one of 365 (16.7%) patients with acute lacunar stroke (median age 71.8 years, 39.5% female, median NIHSS score on admission 3) had END. Lower NIHSS score on admission (per point, aOR 0.81, p=0.006), capsular warning syndrome (aOR 7.00, p<0.001), ventral pontine infarct (aOR 3.49, p=0.008) and hypoperfusion on imaging (aOR 2.13, p=0.026) were associated with END. Acute dual antiplatelet therapy was associated with reduced risk of END (aOR 0.10, p=0.04). Patients with END had less favorable outcome at 90 days (aOR 0.13 p<0.001), but intravenous thrombolysis (IVT) was associated with favorable outcome at 90 days (aOR 3.95, p=0.002).

CONCLUSION

One in six patients with lacunar stroke has END and patients at high risk of END can be identified using radiological and clinical variables. Targeted therapeutic trials for this population seem justified.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that early neurologic deterioration in patients with acute lacunar stroke predicts poorer functional outcome at 90 days as determined by the modified Rankin Scale.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Vynckier, Jan Luc; Maamari, Basel; Grunder, Lorenz Nicolas; Göldlin, Martina Béatrice; Meinel, Thomas Raphael; Kaesmacher, Johannes; Hakim, Arsany; Arnold, Marcel; Gralla, Jan; Seiffge, David Julian and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1526-632X

Publisher:

American Academy of Neurology

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

09 Sep 2021 14:47

Last Modified:

09 Sep 2021 14:47

Publisher DOI:

10.1212/WNL.0000000000012661

PubMed ID:

34400585

BORIS DOI:

10.48350/158350

URI:

https://boris.unibe.ch/id/eprint/158350

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