Stroke, Vol 15, 492-496, Copyright © 1984 by American Heart Association
FL Silver, JW Norris, AJ Lewis and VC Hachinski
Analysis of early deaths after stroke is important, since some deaths may
be preventable. Previous studies have relied on retrospective and often
incomplete clinical data, for comparison with pathological findings. The
present study is based on 1073 consecutive stroke patients admitted to an
intensive care stroke unit from a well-defined population. There were 212
deaths within the first 30 days, yielding a mortality rate of 20%.
Clinical, radiological, and laboratory data were collected prospectively
according to a standardized protocol. Autopsies were performed on 90 of the
212 patients, and CT scanning on a further 27. Early mortality after stroke
exhibits a bimodal distribution. One peak occurs during the first week, and
a second during the second and third weeks. The majority of deaths in the
first week are due to transtentorial herniation. Of these, deaths due to
hemorrhage usually occur within the first three days, whilst deaths due to
infarction peak between the third and sixth day post ictus. After the first
week, deaths due to relative immobility (pneumonia, pulmonary embolism and
sepsis) predominate, peaking towards the end of the second week. Cardiac
deaths occur throughout the first month, and unfortunately account for many
deaths in patients with small functional deficits.
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