Outcome of stroke with mild or rapidly improving symptoms

Nedeltchev, Krassen; Schwegler, Benjamin; Haefeli, Tobias; Brekenfeld, Caspar; Gralla, Jan; Fischer, Urs; Arnold, Marcel; Remonda, Luca; Schroth, Gerhard; Mattle, Heinrich P (2007). Outcome of stroke with mild or rapidly improving symptoms. Stroke, 38(9), pp. 2531-2535. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/STROKEAHA.107.482554

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BACKGROUND AND PURPOSE: Acute ischemic stroke with mild or rapidly improving symptoms is expected to result in good functional outcome, whether treated or not. Therefore, thrombolysis with its potential risks does not seem to be justified in such patients. However, recent studies indicate that the outcome is not invariably benign. METHODS: We analyzed clinical and radiological data of patients with stroke who presented within 6 hours of stroke onset and did not receive thrombolysis because of mild or rapidly improving symptoms. Univariate and logistic regression analyses were performed to define predictors of clinical outcome. RESULTS: One hundred sixty-two consecutive patients (110 men and 52 women) aged 63+/-13 years were included. The median National Institutes of Health Stroke Scale score on admission was 2 (range, 1 to 14). All patients presented within 6 hours of symptom onset. After 3 months, modified Rankin Scale score was </=1 in 122 patients (75%), indicating a favorable outcome. Thirty-eight patients (23.5%) had an unfavorable outcome (modified Rankin Scale 2 to 5) and 2 patients (1.3%) had died. Baseline National Institutes of Health Stroke Scale score >/=10 points increased the odds of unfavorable outcome or death 16.9-fold (95% CI: 1.8 to 159.5; P<0.013), and proximal vessel occlusion increased the odds 7.13-fold (95% CI: 1.1 to 45.5; P<0.038). CONCLUSIONS: Seventy-five percent of patients with mild or rapidly improving symptoms will have a favorable outcome after 3 months. Therefore, a decision against thrombolysis seems to be justified in the majority of patients. However, selected patients, especially those with proximal vessel occlusions and baseline National Institutes of Health Stroke Scale scores >/=10 points, might derive a benefit from thrombolysis.

Item Type:	Journal Article (Original Article)
Division/Institute:	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 and Interventional Neuroradiology 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
UniBE Contributor:	Nedeltchev, Krassen, Haefeli, Tobias, Brekenfeld, Caspar, Gralla, Jan, Fischer, Urs Martin, Arnold, Marcel, Remonda, Luca, Schroth, Gerhard, Mattle, Heinrich
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0039-2499
ISBN:	17673713
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 14:51
Last Modified:	02 Mar 2023 23:22
Publisher DOI:	10.1161/STROKEAHA.107.482554
PubMed ID:	17673713
Web of Science ID:	000249028400024
URI:	https://boris.unibe.ch/id/eprint/21549 (FactScience: 7396)