Stroke, Vol 24, 532-535, Copyright © 1993 by American Heart Association
B Censori, M Camerlingo, L Casto, B Ferraro, GC Gazzaniga, B Cesana and A Mamoli
BACKGROUND AND PURPOSE: We sought to detect prognostic factors related to
functional outcome during the first 6 hours after a first-ever stroke in
the carotid artery territory. METHODS: All patients with these
characteristics seen during a 3-year period were included. Outcome was
evaluated according to a modified Rankin scale. The following variables
were examined at univariate analysis: sex, age, severity of deficit at
entry and at day 7, level of consciousness at entry, time after symptom
onset, history of smoking, history of hypertension, diabetes, myocardial
infarction, atrial fibrillation, rheumatic heart disease, dilated
cardiomyopathy, all potential cardioembolic sources, presence of a
consistent lesion on computed tomography at entry and at days 5-9, and the
size of such lesion. RESULTS: All entry criteria were met by 172 patients.
Age > or = 70 years, a Canadian Neurological Scale score < 6.5 at
entry and at day 7, atrial fibrillation, presence of a potential
cardioembolic source, and a "large" lesion (involving more than half the
cerebral lobe) on computed tomography at days 5-9 were associated with a
significantly worse outcome both at 30 days and at 6 months. After
multivariate analysis, a Canadian Scale score < 6.5 at entry (p <
0.0001) and atrial fibrillation (p = 0.005) were associated with a
significant handicap or death at 30 days, whereas only a Canadian Scale
score < 6.5 (p < 0.0001) was associated with a worse prognosis at 6
months. An association of age > or = 70 years with a worse outcome at 6
months was of borderline significance (p = 0.054). CONCLUSIONS: Some
prognostic indicators are available during the first few hours after onset
of a carotid ischemic stroke and may be useful in the stratification of
patients in clinical trials. Severity of deficit is the most important
indicator, whereas the presence of atrial fibrillation worsens the
prognostic outlook with respect to early handicap but not mortality.
ARTICLES
Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset
Second Division of Neurology, Ospedali Riuniti, Bergamo, Italy.
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