Early neurological worsening in acute ischaemic stroke patients.
OBJECTIVE
Neurological worsening in acute ischaemic stroke patients is common with significant morbidity and mortality.


OBJECTIVE
To determine the factors associated with early neurological worsening within the first 9 h after onset of acute ischaemic stroke.


METHODS
The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Early neurological worsening was defined as NIHSS score increase ≥4 NIHSS points within 9 h of symptom onset compared to NIHSS score within 3 h of symptom onset. Patients with early neurological worsening were compared to patients with unchanged or improved NIHSS scores.


RESULTS
Of the 2484 patients admitted with ischaemic stroke, 552 patients had NIHSS score within 3 h of symptom onset, and 44 (8.0%) experienced early neurological worsening. The median NIHSS on admission was 8.4 in both groups. Early neurological worsening was associated with low body temperature on admission (P = 0.01), proximal compared to distal MCA occlusion (P = 0.007) and with ipsilateral internal carotid artery stenosis >50% or occlusion (P = 0.04). Early neurological worsening was associated with higher NIHSS day 7 (P < 0.001) and higher mortality within 7 days of stroke onset (P = 0.005).


CONCLUSIONS
Early neurological worsening has serious consequences for the short-term outcome for patients with acute ischaemic stroke and is associated with low body temperature on admission, and with extracranially and intracranially large-vessel stenosis or occlusion.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
A
A
Nacu
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
G H
GH
Bringeland
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
A
A
Khanevski
Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
L
L
Thomassen
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
U
U
Waje-Andreassen
Department of Neurology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
H
H
Naess
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors
Early neurological worsening; NIHSS; acute ischaemic stroke; body temperature