title: Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke.
abstract: One-third of patients with acute ischemic stroke develop early neurologic worsening, which is associated with increased mortality and long-term functional disability. We investigated the predictive factors for neurologic deterioration in patients with acute ischemic stroke within 1 week of onset. We retrospectively investigated 643 patients who were admitted within 2 days of acute ischemic stroke between April 2007 and March 2010. Neurologic deterioration was defined as an increase of 4 points or more in the National Institutes of Health Stroke Scale (NIHSS) score within 1 week of admission. We retrieved data on demographic and clinical characteristics, medications, and stroke subtypes. Out of 537 patients, deterioration was noted in 64 patients (11.9%; deterioration group). Multivariate analysis identified history of myocardial infarction (P < .001), NIHSS score ≥8 at onset (P < .001), high leukocyte count (P = .035), low-density lipoprotein cholesterol ≥140 mg/dL (P = .002), and hemoglobin A1c ≥7% (P = .006) as significant factors associated with deterioration. Branch atheromatous disease was more frequent in the deterioration group, and >90% of patients with deterioration either were discharged to nursing home care or died. Multivariate analysis of magnetic resonance imaging findings identified internal carotid/middle cerebral artery occlusion (each P < .001), striate capsular infarction (P = .030), pontine infarction (P = .047), and lesion size of 15-30 mm (P = .011) as independent factors associated with deterioration. Stroke patients with a high low-density lipoprotein level, high hemoglobin A1c level on admission, a history of myocardial infarction, and high NIHSS score are at high risk for neurologic deterioration. Patients with multiple risk factors for deterioration can benefit most from intensive monitoring.
authors: Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan. nobu-m@juntendo.ac.jp
authors: Nobukazu
authors: N
authors: Miyamoto
authors: Yasutaka
authors: Y
authors: Tanaka
authors: Yuji
authors: Y
authors: Ueno
authors: Miyako
authors: M
authors: Kawamura
authors: Yoshiaki
authors: Y
authors: Shimada
authors: Ryota
authors: R
authors: Tanaka
authors: Nobutaka
authors: N
authors: Hattori
authors: Takao
authors: T
authors: Urabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008075:Lipoproteins, HDL / Q000097:blood; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009460:Neurologic Examination; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D008075:Lipoproteins, HDL; C517652:hemoglobin A1c protein, human