From the Departments of Neurology (K.C.J., E.C.H.) and Neurosurgery
(J.Y.L., E.C.H.), University of Virginia (Charlottesville); the Department of
Neurology, University of California at San Diego (P.D.L.); Park Nicollet
Medical Foundation, St Louis Park, Minn (S.K.H.); Foothills Hospital, Calgary,
Alberta, Canada (T.E.F.); the Department of Neurology, Medical College of
Georgia (Augusta) (R.J.A.); and the Department of Neurology, University of
Alabama (Birmingham) (R.E.F.).
Correspondence to Karen C. Johnston, MD, Department of Neurology, Box 394, University of Virginia Health Sciences Center, Charlottesville, VA 22908. E-mail kj4v{at}virginia.edu
Background and Purpose—Medical
and neurological complications after acute ischemic stroke may
adversely impact outcome and in some cases may be preventable. Limited
data exist regarding the frequency of such complications occurring in
the first days after the ictus and the relationship of these
complications to outcome. Our objective was to identify the types,
severity, and frequency of medical and neurological complications
following acute ischemic stroke and to determine their role in
mortality and functional outcome.
Methods—Rates of serious (life-threatening) and nonserious
medical and neurological complications and mortality were derived from
the placebo limb of the Randomized Trial of Tirilazad Mesylate in Acute
Stroke (RANTTAS) database (n=279). Complications were correlated with
clinical outcome using logistic regression techniques.
Results—Of all patients, 95% had at least one
complication. The most common serious medical complication was
pneumonia (5%), and the most common serious neurological complication
was new cerebral infarction or extension of the admission infarction
(5%). The 3-month mortality was 14%; 51% of these deaths were
attributed primarily to medical complications. Outcome was
significantly worse in patients with serious medical complications,
after adjustment for baseline imbalances, as measured by the Barthel
Index (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.5 to
15.1) and by the Glasgow Outcome Scale (OR, 11.6; 95% CI, 4.3 to
30.9). After death was discounted, serious medical complications were
associated with severe disability at 3 months as determined by the
Glasgow Outcome Scale (OR, 4.4; 95% CI, 1.3 to 14.8).
Conclusions—Medical complications that follow
ischemic stroke not only influence mortality but may influence
functional outcome.
© 1998 American Heart Association, Inc.
Original Contributions
Medical and Neurological Complications of Ischemic Stroke
Experience From the RANTTAS Trial
Key Words: complications • stroke • stroke, acute • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  T Molnar, A Peterfalvi, L Szereday, G Pusch, L Szapary, S Komoly, L Bogar, and Z Illes Deficient leucocyte antisedimentation is related to post-stroke infections and outcome J. Clin. Pathol., November 1, 2008; 61(11): 1209 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Hilz and S. Schwab Stroke-Induced Sudden-Autonomic Death: Areas of Fatality Beyond the Insula Stroke, September 1, 2008; 39(9): 2421 - 2422. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. O'Donnell, M. K. Kapral, J. Fang, G. Saposnik, J. W. Eikelboom, W. Oczkowski, J. Silva, L. Gould, C. D'Uva, F. L. Silver, et al. Gastrointestinal bleeding after acute ischemic stroke Neurology, August 26, 2008; 71(9): 650 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Thanvi, S Treadwell, and T Robinson Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management Postgrad. Med. J., August 1, 2008; 84(994): 412 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Indredavik, G. Rohweder, E. Naalsund, and S. Lydersen Medical Complications in a Comprehensive Stroke Unit and an Early Supported Discharge Service Stroke, February 1, 2008; 39(2): 414 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Bravata, S.-Y. Ho, T. P. Meehan, L. M. Brass, and J. Concato Readmission and Death After Hospitalization for Acute Ischemic Stroke: 5-Year Follow-Up in the Medicare Population Stroke, June 1, 2007; 38(6): 1899 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rocco, M. Pasquini, E. Cecconi, G. Sirimarco, M. C. Ricciardi, E. Vicenzini, M. Altieri, V. Di Piero, and G. L. Lenzi Monitoring After the Acute Stage of Stroke: A Prospective Study Stroke, April 1, 2007; 38(4): 1225 - 1228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S.V. Elkind, S. Prabhakaran, J. Pittman, W. Koroshetz, M. Jacoby, K. C. Johnston, and for the GAIN Americas Investigators Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke Neurology, March 13, 2007; 68(11): 842 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, X. Urra, and A. M. Planas Infection After Acute Ischemic Stroke: A Manifestation of Brain-Induced Immunodepression Stroke, March 1, 2007; 38(3): 1097 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Gee, A. Kalil, C. Shea, and K. J. Becker Lymphocytes: Potential Mediators of Postischemic Injury and Neuroprotection Stroke, February 1, 2007; 38(2): 783 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Chamorro, S Amaro, M Vargas, V Obach, A Cervera, F Torres, and A M Planas Interleukin 10, monocytes and increased risk of early infection in ischaemic stroke. J. Neurol. Neurosurg. Psychiatry, November 1, 2006; 77(11): 1279 - 1281. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Prass, J. S. Braun, U. Dirnagl, C. Meisel, and A. Meisel Stroke Propagates Bacterial Aspiration to Pneumonia in a Model of Cerebral Ischemia Stroke, October 1, 2006; 37(10): 2607 - 2612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Vargas, J. P. Horcajada, V. Obach, M. Revilla, A. Cervera, F. Torres, A. M. Planas, J. Mensa, and A. Chamorro Clinical Consequences of Infection in Patients With Acute Stroke: Is It Prime Time for Further Antibiotic Trials? Stroke, February 1, 2006; 37(2): 461 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-J. Bae, D.-S. Yoon, J. Lee, B.-K. Kim, J.-S. Koo, O. Kwon, and J.-M. Park In-Hospital Medical Complications and Long-Term Mortality After Ischemic Stroke Stroke, November 1, 2005; 36(11): 2441 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, J.P. Horcajada, V. Obach, M. Vargas, M. Revilla, F. Torres, A. Cervera, A.M. Planas, and J. Mensa The Early Systemic Prophylaxis of Infection After Stroke Study: A Randomized Clinical Trial Stroke, July 1, 2005; 36(7): 1495 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C. Haley Jr, P. D. Lyden, K. C. Johnston, T. M. Hemmen, and the TNK in Stroke Investigators A Pilot Dose-Escalation Safety Study of Tenecteplase in Acute Ischemic Stroke Stroke, March 1, 2005; 36(3): 607 - 612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Zurasky, V. Aiyagari, A. R. Zazulia, A. Shackelford, and M. N. Diringer Early mortality following spontaneous intracerebral hemorrhage Neurology, February 22, 2005; 64(4): 725 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Di Angelantonio, M Fiorelli, D Toni, M L Sacchetti, S Lorenzano, A Falcou, M V Ciarla, M Suppa, L Bonanni, G Bertazzoni, et al. Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 76 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Meisel, K. Prass, J. Braun, I. Victorov, T. Wolf, D. Megow, E. Halle, H.-D. Volk, U. Dirnagl, and A. Meisel Preventive Antibacterial Treatment Improves the General Medical and Neurological Outcome in a Mouse Model of Stroke Stroke, January 1, 2004; 35(1): 2 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cavallini, G. Micieli, S. Marcheselli, and S. Quaglini Role of Monitoring in Management of Acute Ischemic Stroke Patients Stroke, November 1, 2003; 34(11): 2599 - 2603. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Prass, C. Meisel, C. Hoflich, J. Braun, E. Halle, T. Wolf, K. Ruscher, I. V. Victorov, J. Priller, U. Dirnagl, et al. Stroke-induced Immunodeficiency Promotes Spontaneous Bacterial Infections and Is Mediated by Sympathetic Activation Reversal by Poststroke T Helper Cell Type 1-like Immunostimulation J. Exp. Med., September 2, 2003; 198(5): 725 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Lees, H.-C. Diener, K. Asplund, and M. Krams UK-279,276, a Neutrophil Inhibitory Glycoprotein, in Acute Stroke: Tolerability and Pharmacokinetics Stroke, July 1, 2003; 34(7): 1704 - 1709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
I. L. Katzan, R. D. Cebul, S. H. Husak, N. V. Dawson, and D. W. Baker The effect of pneumonia on mortality among patients hospitalized for acute stroke Neurology, February 25, 2003; 60(4): 620 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. C. Johnston, D. P. Wagner, E. C. Haley Jr, and A. F. Connors Jr Combined Clinical and Imaging Information as an Early Stroke Outcome Measure Stroke, February 1, 2002; 33(2): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, A. M. Demchuk, J. Berrouschot, E. Schmutzhard, L. Harms, P. Verro, J. A. Chalela, R. Abbur, H. McGrade, I. Christou, et al. Predictors of Fatal Brain Edema in Massive Hemispheric Ischemic Stroke Stroke, September 1, 2001; 32(9): 2117 - 2123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kelly, A. Rudd, R. Lewis, and B. J. Hunt Venous Thromboembolism After Acute Stroke Stroke, January 1, 2001; 32(1): 262 - 267. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
|
|
Tirilazad Mesylate in Acute Ischemic Stroke : A Systematic Review Stroke, September 1, 2000; 31(9): 2257 - 2265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Langhorne, D. J. Stott, L. Robertson, J. MacDonald, L. Jones, C. McAlpine, F. Dick, G. S. Taylor, and G. Murray Medical Complications After Stroke : A Multicenter Study Stroke, June 1, 2000; 31(6): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Phase II Studies of the Glycine Antagonist GV150526 in Acute Stroke : The North American Experience Stroke, February 1, 2000; 31(2): 358 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Schmid-Elsaesser, E. Hungerhuber, S. Zausinger, A. Baethmann, H.-J. Reulen, and J. A. Zivin Combination Drug Therapy and Mild Hypothermia : A Promising Treatment Strategy for Reversible, Focal Cerebral Ischemia • Editorial Comment: A Promising Treatment Strategy for Reversible, Focal Cerebral Ischemia Stroke, September 1, 1999; 30 (9): e1891 - 1899. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. DeGraba, J. M. Hallenbeck, K. D. Pettigrew, A. J. Dutka, and B. J. Kelly Progression in Acute Stroke : Value of the Initial NIH Stroke Scale Score on Patient Stratification in Future Trials Stroke, June 1, 1999; 30(6): 1208 - 1212. [Abstract] [Full Text] [PDF]
|
|