title: Neurofluctuation in patients with subcortical ischemic stroke.
abstract: OBJECTIVE
  The purpose of this study was to assess the incidence of deterioration, fluctuation, and associated risk of poor outcome in patients with subcortical stroke (SCS).
  
  
  METHODS
  We conducted a prospective observational study, enrolling patients admitted with SCS based on their clinical examination and imaging studies. An NIH Stroke Scale evaluation was performed daily and whenever deterioration in examination was detected. Neurologic deterioration was defined as a motor score increase of at least 1 on the NIH Stroke Scale. Modified Rankin Scale scores at discharge were used to assess outcome.
  
  
  RESULTS
  Among 90 enrolled patients, 37 (41%) deteriorated, 75% of them in the first 24 hours after enrollment. Administration of tissue plasminogen activator was significantly associated with deterioration (hazard ratio 2.25; 95% confidence interval [CI]: 1.13-4.49) even after controlling for the association of deterioration with the early poststroke period. Deterioration conferred an increased risk of poor outcome (modified Rankin Scale scores 3-6) at discharge (relative risk: 1.80; 95% CI: 1.71-1.93). Reversion back to predeterioration deficits occurred in 38% of patients, and was associated with reduced risk of poor outcome at discharge (relative risk: 0.12; 95% CI: 0.02-0.83). Treatment with tissue plasminogen activator conferred better chances of spontaneous recovery to predeterioration deficits after initial deterioration (hazard ratio: 4.36; 95% CI: 1.36-14.01).
  
  
  CONCLUSIONS
  More than 40% of patients with SCS deteriorate neurologically. Deterioration tends to occur early after stroke, spontaneously reverses in approximately one-third of cases, and poses an increased risk of poor outcome. Therapies are needed to prevent, arrest, or reverse deterioration in patients with SCS.
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Farhaan S
authors: FS
authors: Vahidy
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: William J
authors: WJ
authors: Hicks
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Indrani
authors: I
authors: Acosta
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Hen
authors: H
authors: Hallevi
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Hui
authors: H
authors: Peng
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Renganayaki
authors: R
authors: Pandurengan
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Nicole R
authors: NR
authors: Gonzales
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Andrew D
authors: AD
authors: Barreto
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Sheryl
authors: S
authors: Martin-Schild
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Tzu-Ching
authors: TC
authors: Wu
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Mohammad H
authors: MH
authors: Rahbar
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: Arvind B
authors: AB
authors: Bambhroliya
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston.
authors: James C
authors: JC
authors: Grotta
authors: From the Department of Neurology, Medical School (F.S.V., W.J.H., I.A., H.H., N.R.G., A.D.B., S.M.-S., T.-C.W., A.B.B., J.C.G., S.I.S.), Center for Clinical and Translational Sciences (H.P., R.P., M.H.R.), and Department of Epidemiology, Human Genetic and Environmental Sciences, School of Public Health (M.H.R.), University of Texas Health Science Center at Houston. Sean.I.Savitz@uth.tmc.edu.
authors: Sean I
authors: SI
authors: Savitz
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator