title: Stroke scale items associated with neurologic deterioration within 24 hours after recombinant tissue plasminogen activator therapy.
abstract: It is unclear when and which neurologic deficits should be examined within 24 hours after intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute ischemic stroke. Relationships between serial changes in National Institutes of Health Stroke Scale (NIHSS) subscores and neurologic deterioration (ND) within the first 24 hours after therapy were investigated in 43 consecutive patients. The NIHSS score was measured by neurologists 28 times within 24 hours after therapy. Assessments of subscores associated with ND, defined as the first change 4 or more points from baseline, were performed at 15 minutes (most frequent time of the first ND), 120 minutes (median time of the first ND), and 24 hours after therapy. Seventeen of 43 patients (age range, 55-94 years) showed ND. Of the NIHSS subscores, increases in scores for loss of consciousness (15 minutes, P = .001; 120 minutes, P = .026; 24 hours, P = .018) and motor limbs total (15 minutes, P = .014; 120 minutes, P = .031) were related to deterioration. Items such as questions, gaze, visual fields, ataxia, language, dysarthria, and extinction/inattention were not related to deterioration at any time. In conclusion, ND of ischemic stroke patients treated with intravenous rt-PA therapy was frequently seen within 120 minutes after therapy. Items such as loss of consciousness and motor limbs total may be considered indices for monitoring neurologic deficits after therapy.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan. Electronic address: nanriyu@cc.saga-u.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nanri
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yakushiji
authors.forename: Megumi
authors.initials: M
authors.lastname: Hara
authors.forename: Makoto
authors.initials: M
authors.lastname: Eriguchi
authors.forename: Ryuichirou
authors.initials: R
authors.lastname: Okada
authors.forename: Motohiro
authors.initials: M
authors.lastname: Yukitake
authors.forename: Hideo
authors.initials: H
authors.lastname: Hara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001259:Ataxia / Q000175:diagnosis / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014474:Unconsciousness / Q000175:diagnosis / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator