Published Online
on July 8, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on January 7, 2004
Revised on March 10, 2004
Accepted on April 13, 2004

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, California.

^* To whom correspondence should be addressed. 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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