title: The role of small vessel disease in re-exacerbation of stroke symptoms within 24 hours after tissue plasminogen activator infusion.
abstract: BACKGROUND
  The purpose of this study was to examine the frequency and characteristics of re-exacerbation of stroke symptoms within 24 hours after tissue plasminogen activator (t-PA) infusion.
  
  
  METHODS
  We studied consecutive stroke patients treated with t-PA within 3 hours of onset of symptoms admitted between October 2005 and March 2010. We divided patients into 4 groups: improvement (IM; improvement in National Institutes of Health Stroke Scale [NIHSS] ≥4 points), unchanged (UN; no change or decline in NIHSS <4 points), exacerbation (EX; decline in NIHSS ≥4 points), and re-exacerbation (RE-EX; decline of NIHSS ≥4 points accompanied by re-exacerbation of neurologic symptoms in NIHSS ≥4 points). We compared clinical characteristics among the 4 groups.
  
  
  RESULTS
  Two hundred twenty-two patients (135 men; median age 76 years) were enrolled. Sixteen of the 222 (7%) were in the RE-EX group. Small vessel disease (SVD), hemorrhagic cerebral infarction, and reocclusion were significantly more common among patients in the RE-EX group. SVD, hemorrhagic cerebral infarction, and reocclusion occurred in 44%, 25%, and 13% of patients in the RE-EX group, in 9%, 22%, and 0% of patients in the EX group, in 5%, 6%, and 0% of patients in the IM group, and in 17%, 14%, and 1% of patients in the UN group, respectively (P < .001, P = .041, and P < .001). Multivariate logistic regression analysis revealed that SVD was the only independent factor associated with re-exacerbation within 24 hours after t-PA infusion (odds ratio 3.52; 95% confidence interval [CI] 1.19-10.40; P = .023).
  
  
  CONCLUSIONS
  Seven percent of patients re-exacerbated within 24 hours after intravenous infusion of t-PA. Re-exacerbation within 24 hours after t-PA infusion was strongly associated with SVD.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. Electronic address: uemuratrail@yahoo.co.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D059345:Cerebral Small Vessel Diseases / Q000150:complications*; D038524:Diffusion Magnetic Resonance Imaging; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012008:Recurrence; D020521:Stroke / Q000150:complications* / Q000503:physiopathology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator