Early recovery after cerebral ischemia risk of subsequent neurological deterioration.
Given the high short-term risk of stroke after transient ischemic attack, we hypothesized that substantial acute neurological recovery in patients presenting with cerebral ischemia would be associated with a greater risk of subsequent neurological deterioration due to recurrent cerebral ischemia. Data from the Trial of ORG10172 in Acute Stroke Treatment, a randomized trial of the heparinoid danaparoid, were analyzed to determine whether substantial acute recovery, defined as an improvement of greater than or equal to 75% on National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 hours, was associated with a greater risk of subsequent deterioration, defined as a worsening on the NIHSS between day 1 and day 90. Of 1,184 subjects meeting entry criteria, 63 (5.3%) had substantial acute recovery. Subsequent deterioration was more common in those with substantial acute recovery compared with others (48 vs 33%; p = 0.028 by Fisher's exact test). In multivariable models, substantial acute recovery remained an independent predictor of subsequent deterioration (odds ratio, 3.0; 95% confidence interval, 1.7-5.2; p < 0.001). Among patients with acute cerebral ischemia, those who recover substantially within 24 hours may be at greater risk of subsequent neurological deterioration due to causes other than hemorrhage.
Johnston
S Claiborne
SC
Department of Neurology, University of California, San Francisco, CA 94143-0114, USA. clay.johnston@ucsfmedctr.org
Leira
Enrique C
EC
Hansen
Michael D
MD
Adams
Harold P
HP
D000368:Aged; D000925:Anticoagulants; D001786:Blood Glucose; D001794:Blood Pressure; D016022:Case-Control Studies; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000627:therapeutic use; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D002546:Ischemic Attack, Transient / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000178:diet therapy / Q000209:etiology*; D009460:Neurologic Examination; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012306:Risk; D013997:Time Factors
D000925:Anticoagulants; D001786:Blood Glucose; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006497:Heparan Sulfate; C035838:danaparoid