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
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