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Early neurological deterioration in acute ischemic stroke

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Abstract

Background and aims

Early neurological deterioration (END) in acute ischemic stroke (AIS), patients is defined as clinical worsening or recurrence during first 72 h after onset of AIS. We have conducted this study to determine the association between END and functional outcome at 3 months of onset of AIS along with associated risk factors of END in AIS cases.

Methodology

This study was conducted after approval of Institute Ethics Committee. Two hundred three consecutive patients were admitted from September 2020 to January 2022 at a tertiary care hospital. One hundred ninety patients were included in the study; patients were divided into two groups: (1) early neurological deterioration (END) and (2) non-early neurological deterioration (non-END). Patients were followed-up either telephonically or in person at approximately 3 months using modified Rankin Scale 0–6. All the clinically significant prognostic markers and p < 0.10 variables were considered significant in univariate analysis; P < 0.05 were considered statistically significant for the multivariate analysis.

Results

Out of 190 cases included in the cohort 34/190 (17.8%) cases showed END with mean age (56.56 (± 16.6)) and males (20/34 (58.8%)). END was independently associated with high blood glucose at admission (OR = 1.015; P = 0.002; 95%CI = 1.005–1.024) and low serum albumin (OR = 0.208; P = 0.002; 95%CI = 0.077–0.562). Patients with END showed poor functional outcome (mRS > 2) at end of 3 months (32 (94.1%); P < 0.001) and death was also statistically significant (22 (64.7%); P < 0.001) as compared to AIS cases having non-END.

Conclusion

Our study showed END may be associated with poor functional outcome in AIS patients. Higher blood glucose at admission and low serum albumin may be statistically significant causing END. Future prospective cohort with larger sample size may confirm the findings.

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Data is available with us in anonymous form, maintaining the confidentiality of individual patients.

References

  1. Global Burden of Disease 2017 (2018) Causes of death collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1736–1788

  2. Directorate General of Health Services: Ministry of Health and Family Welfare (2019) National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Government of India. https://main.mohfw.gov.in/MajorProgrammes/non-communicable-diseases-injury-trauma/ Non-Communicable-Disease-II/National-Programmefor-Prevention-and-Control-of-Cancer-DiabetesCardiovascular-diseases-and-Stroke-NPCDCS (2019, accessed 21 September 2020)

  3. Jones SP, Baqai K, Clegg A et al (2021) Stroke in India: a systematic review of the incidence, prevalence, and case fatality. Int J Stroke 17474930211027834. https://doi.org/10.1177/17474930211027834. Epub ahead of print. PMID: 34114912

  4. Ferrari J, Knoflach M, Kiechl S et al (2010) Early clinical worsening in patients with TIA or minor stroke: the Austrian Stroke Unit Registry. Neurology 74:136–141

    Article  CAS  PubMed  Google Scholar 

  5. Thanvi B, Treadwell S, Robinson T (2008) Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgrad Med J 994:412–417

    Article  Google Scholar 

  6. Roden-Jullig A (1997) Progressing stroke: epidemiology. Cerebrovasc Dis 7(suppl 5):2–5

    Article  Google Scholar 

  7. Tei H, Uchiyama S, Ohara K et al (2000) Deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project. Stroke 31:2049–2054

    Article  CAS  PubMed  Google Scholar 

  8. De Graba TJ, Hallenbeck JM, Pettigrew KD et al (1999) Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials. Stroke 30:1208–1212

    Article  Google Scholar 

  9. Tanne D, Haim M, Goldbourt U et al (2003) Prospective study of serum homocysteine and risk of ischemic stroke among patients with preexisting coronary heart disease. Stroke 34:632–636

    Article  PubMed  Google Scholar 

  10. Wityke RJ, Pessin MS, Kaplan RF et al (1994) Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 25:362–365

    Article  Google Scholar 

  11. Zhang X, Sun Z, Ding C et al (2016) Metabolic syndrome augments the risk of early neurological deterioration in acute ischemic stroke patients independent of inflammatory mediators: a hospital-based prospective study. Oxid Med Cell Longev 2016:8346301

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim YD, Song D, Kim EH et al (2014) Long-term mortality according to the characteristics of early neurological deterioration in ischemic stroke patients. Yonsei Med J 55:669–675

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim JT, Heo SH, Yoon W et al (2016) Clinical outcomes of patients with acute minor stroke receiving rescue IA therapy following early neurological deterioration. J NeuroIntervent Surg 8:461–465

    Article  Google Scholar 

  14. Kwon HM, Lee YS, Bae HJ et al (2014) Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke 45:871–873

    Article  CAS  PubMed  Google Scholar 

  15. Toni D, Fiorelli M, Gentile M et al (1995) Progressing neurological deficit secondary to acute ischemic stroke: a study on predictability, pathogenesis, and prognosis. Arch Neurol 52:670–675

    Article  CAS  PubMed  Google Scholar 

  16. Kwon HM, Lim JS, Park HK et al (2011) Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke. J Neurol Sci 309:128–130

    Article  PubMed  Google Scholar 

  17. Geng et al (2017) Early neurological deterioration during the acute phase as a predictor of long-term outcome after first-ever ischemic stroke. Medicine 96:51

    Article  Google Scholar 

  18. Davalos A, Cendra E, Teruel J et al (1990) Deteriorating ischemic stroke: risk factors and prognosis. Neurology 40:1865–1869

    Article  CAS  PubMed  Google Scholar 

  19. Siegler JE, Boehme AK, Kumar AD et al (2013) What change in the national institutes of health stroke scale should define neurologic deterioration in acute ischemic stroke? J Stroke Cerebrovasc Dis 22:675–682

    Article  PubMed  Google Scholar 

  20. Vila N, Castillo J, Dávalos A, Chamorro A (2000) Proinflammatory cytokines and early neurological worsening in ischemic stroke. Stroke 31:2325–2329

    Article  CAS  PubMed  Google Scholar 

  21. Lin LC, Yang JT, Weng HH et al (2011) Predictors of early clinical deterioration after acute ischemic stroke. Am J Emerg Med 29:577–581

    Article  PubMed  Google Scholar 

  22. Kwan J, Hand P (2006) Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 99:625–633

    Article  CAS  PubMed  Google Scholar 

  23. Bhatia K, Mohanty S, Tripathy BK et al (2015) Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity. Indian J Med Res 141:299–307

  24. Barber M, Wright F, Stott DJ et al (2004) Predictors of early neurological deterioration after ischaemic stroke: a case-control study. Gerontology 50:102–109

    Article  PubMed  Google Scholar 

  25. Potter J, Robinson T, Ford G et al (2005) for the CHHIPS Trial Group. CHHIPS (Controlling Hypertension and Hypotension Immediately Post-Stroke) pilot trial: rationale and design. J Hypertens 23:649–55

  26. The ENOS Trial Investigators (2006) Glyceryl trinitrate vs. control, and continuing vs. stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the Efficacy of Nitric Oxide in Stroke (ENOS) trial (ISRCTN99414122). Int J Stroke 1:245–9

  27. COSSACS Trial Group (2005) COSSACS (Continue or Stop Post-Stroke Antihypertensives Collaborative Study): rationale and design. J Hypertens 23:455–458

    Article  Google Scholar 

  28. Lindsberg PJ, Roine RO (2004) Hyperglycemia in acute stroke. Stroke 35:363–364

    Article  PubMed  Google Scholar 

  29. Parsons MW, Barber PA, Desmond PM et al (2002) Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 52:20–28

    Article  PubMed  Google Scholar 

  30. Kase CS, Furlan AJ, Wechsler LR et al (2001) Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke: the PROACT II trial. Neurology 57:1603–1610

    Article  CAS  PubMed  Google Scholar 

  31. Candelise L, Landi G, Orazio EN et al (1985) Prognostic significance of hyperglycemia in acute stroke. Arch Neurol 42:661–663

    Article  CAS  PubMed  Google Scholar 

  32. Gray CS, Hildreth AJ, Sandercock PA et al (2007) for the GIST Trialists Collaboration. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol 6:397–406

  33. Bruno A, Biller J, Adams HP Jr et al (1999) for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Acute blood glucose level and outcome from ischemic stroke. Neurology 52:280–284

  34. Bruno A, Levine SR, Frankel MR et al (2002) for the NINDS rt-PA Stroke Study Group. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology 59:669–674

  35. Jorgensen HS, Nakayama H, Raaschou HO et al (1994) Effect of blood pressure and diabetes on stroke in progression. Lancet 344:156–159

    Article  CAS  PubMed  Google Scholar 

  36. Baird TA, Parsons MW, Phanh T et al (2003) Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 34:2208–2214

    Article  CAS  PubMed  Google Scholar 

  37. Weimar C, Mieck T, Buchthal J et al (2005) for the German Stroke Study Collaboration. Neurologic worsening during the acute phase of ischemic stroke. Arch Neurol 62:393–7

  38. Rajajee V, Kidwell C, Starkman S et al (2006) Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. Neurology 67:980–984

    Article  CAS  PubMed  Google Scholar 

  39. Castillo J, Leira R, Garcia MM et al (2004) Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke 35:520–526

    Article  PubMed  Google Scholar 

  40. Britton M, Roden A (1985) Progression of stroke after arrival at hospital. Stroke 16:629–632

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fellowship Neuroendovascular Therapy, Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Archana Sharma, Awadh Kishor Pandit, Biswamohan Mishra, Madakasira Vasantha Padma Srivastava, Achal Kumar Srivastava, Venugopalan Y. Vishnu & Rajesh Kumar Singh

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  1. Archana Sharma
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Sharma, A., Pandit, A.K., Mishra, B. et al. Early neurological deterioration in acute ischemic stroke. Ir J Med Sci 193, 949–955 (2024). https://doi.org/10.1007/s11845-023-03485-5

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