Poststroke neurological improvement within 7 days is associated with subsequent deterioration.
OBJECTIVE
Improvement in the National Institutes of Health Stroke Scale (NIHSS) 24 hours after stroke has been associated with subsequent neurological deterioration. We hypothesized that a similar association would be apparent for events occurring after 7 days, when acute changes from edema and herniation are less common. We evaluated the degree of NIHSS improvement at 7 days (recovery) as a predictor of subsequent neurological deterioration from day 7 to day 90.


METHODS
We studied all patients of the Glycine Antagonist (gavestinel) In Neuroprotection (GAIN) International Trial with ischemic stroke alive at day 7, excluding patients with hemorrhagic events and deaths from nonstroke-related causes. The GAIN International Trial was a randomized, double-blind, placebo-controlled, and parallel-group trial; because the study drug had no effect on stroke outcome, treatment groups were combined for this analysis. Neurological deterioration was assessed by the combined measure, including: (1) stroke-related events recorded as "serious adverse events," (2) recurrent stroke recorded on a separate case report form, and (3) any NIHSS worsening.


RESULTS
Among 1187 patients included, 25% had >65% recovery. Deterioration was more prevalent in the group with >65% early recovery (15.5% versus 10.3%; P=0.01). Logistic regression modeling indicated that recovery was associated with subsequent neurological deterioration (odds ratio, 1.2; 95% CI, 1.1 to 1.3, per 10% recovery) after adjusting for age, NIHSS at 7 days, and stroke subtype.


CONCLUSIONS
Substantial neurological recovery at 7 days is associated with subsequent neurological deterioration.
Aslanyan
Stella
S
Division of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, United Kingdom. 0110768a@student.gla.ac.uk
Weir
Christopher J
CJ
Johnston
S Claiborne
SC
Lees
Kennedy R
KR
D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology*; D001929:Brain Edema / Q000209:etiology; D002545:Brain Ischemia / Q000209:etiology; D015331:Cohort Studies; D004311:Double-Blind Method; D004677:Encephalocele / Q000209:etiology; D005260:Female; D005998:Glycine / Q000037:antagonists & inhibitors; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors
C105319:3-(2-((phenylamino)carbonyl)ethenyl)-4,6-dichloroindole-2-carboxylic acid; D007211:Indoles; D018696:Neuroprotective Agents; D005998:Glycine