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(Stroke. 2004;35:2165.)
© 2004 American Heart Association, Inc.

Original Contributions

Poststroke Neurological Improvement Within 7 Days Is Associated With Subsequent Deterioration

Stella Aslanyan, MD; Christopher J. Weir, PhD; S. Claiborne Johnston, MD, PhD Kennedy R. Lees, MD, FRCP for the GAIN International Steering Committee and Investigators

From the Division of Cardiovascular and Medical Sciences (S.A., C.J.W., K.R.L.) and the Robertson Centre for Biostatistics (C.J.W.), University of Glasgow, Scotland; and the Departments of Neurology and Epidemiology (S.C.J.), University of California, San Francisco, Calif.

Correspondence to Dr S. Aslanyan, Division of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, United Kingdom. E-mail 0110768a{at}student.gla.ac.uk

Background and Purpose— Improvement in the National Institutes of Health Stroke Scale (NIHSS) 24 hours after stroke has been associated with subsequent neurological deterioration. We hypothesized that a similar association would be apparent for events occurring after 7 days, when acute changes from edema and herniation are less common. We evaluated the degree of NIHSS improvement at 7 days (recovery) as a predictor of subsequent neurological deterioration from day 7 to day 90.

Methods— We studied all patients of the Glycine Antagonist (gavestinel) In Neuroprotection (GAIN) International Trial with ischemic stroke alive at day 7, excluding patients with hemorrhagic events and deaths from nonstroke-related causes. The GAIN International Trial was a randomized, double-blind, placebo-controlled, and parallel-group trial; because the study drug had no effect on stroke outcome, treatment groups were combined for this analysis. Neurological deterioration was assessed by the combined measure, including: (1) stroke-related events recorded as "serious adverse events," (2) recurrent stroke recorded on a separate case report form, and (3) any NIHSS worsening.

Results— Among 1187 patients included, 25% had >65% recovery. Deterioration was more prevalent in the group with >65% early recovery (15.5% versus 10.3%; P=0.01). Logistic regression modeling indicated that recovery was associated with subsequent neurological deterioration (odds ratio, 1.2; 95% CI, 1.1 to 1.3, per 10% recovery) after adjusting for age, NIHSS at 7 days, and stroke subtype.

Conclusions— Substantial neurological recovery at 7 days is associated with subsequent neurological deterioration.

Key Words: cerebral infarction • disease progression • recovery of function • recurrence

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