title: Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: predictive factors and prognosis.
abstract: OBJECTIVE
  Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis.
  
  
  METHODS
  We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS≥10 were included. Improvement of ≥10 or a score ≤3 24h after thrombolysis was defined as DR.
  
  
  RESULTS
  In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p=0.024), less total anterior circulation infarcts (p=0.009), more partial anterior circulation infarcts (p=0.003) and lower blood glucose on admission (118 vs 128mg/dL, p=0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p=0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p<0.001). Intracranial hemorrhage on 24h-control CT scan was less frequent in the DR group (p<0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR=2.35, 95%CI=1.32-4.16, p=0.003) and CT evidence of recanalization was independently associated with DR (OR=11.60, 95%CI, 3.02-44.53, p<0.001).
  
  
  CONCLUSIONS
  DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization.
authors: Neurology Department of Hospital de Braga, Braga, Portugal. Electronic address: joaomrocha@gmail.com.
authors: João
authors: J
authors: Rocha
authors: Neurology Department of Hospital de Braga, Braga, Portugal.
authors: João
authors: J
authors: Pinho
authors: Neurology Department of Hospital de Braga, Braga, Portugal.
authors: Sara
authors: S
authors: Varanda
authors: Neuroradiology Department of Hospital de Braga, Braga, Portugal.
authors: José
authors: J
authors: Amorim
authors: Neuroradiology Department of Hospital de Braga, Braga, Portugal.
authors: Jaime
authors: J
authors: Rocha
authors: Neurology Department of Hospital de Braga, Braga, Portugal.
authors: João Ramalho
authors: JR
authors: Fontes
authors: Neurology Department of Hospital de Braga, Braga, Portugal.
authors: Ricardo
authors: R
authors: Maré
authors: Neurology Department of Hospital de Braga, Braga, Portugal.
authors: Carla
authors: C
authors: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000187:drug effects; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ischemic stroke; Predictors; Prognosis; Recovery; Thrombolysis