Outcome of stroke with mild or rapidly improving symptoms.
OBJECTIVE
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 < or =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 > or =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.
Nedeltchev
Krassen
K
Department of Neurology, University Hospital of Bern, Bern, Switzerland. krassen.nedeltchev@insel.ch
Schwegler
Benjamin
B
Haefeli
Tobias
T
Brekenfeld
Caspar
C
Gralla
Jan
J
Fischer
Urs
U
Arnold
Marcel
M
Remonda
Luca
L
Schroth
Gerhard
G
Mattle
Heinrich P
HP
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome