Abstract 3472: Neurofluctuations in Patients with Subcortical Ischemic Stroke (NISS)
Objective: Patients with progressive strokes during hospitalization have increased morbidity and mortality as well as worsened functional outcome compared with those who remain stable. While the reported rate of fluctuations in subcortical stroke patients has ranged between 20 to 70%, there are no prospective “natural history” data regarding in-hospital deterioration, neurofluctuation, and reversion back to baseline. The purpose of this prospective study was to capture the incidence of fluctuations and their outcome in subcortical stroke patients receiving standard of care (antiplatelet drugs, intravenous fluids, and bed rest).
Methods: We conducted a prospective study of all patients with subcortical strokes identified based on their clinical exam and routine imaging studies. Informed consent was obtained and demographics collected. An NIH stroke scale (NIHSS) was performed daily and whenever symptoms worsened (defined as a motor score increase of at least 1 on the NIHSS). Modified Rankin scales (mRS) were obtained at 90 days.
Results: 90 patients were prospectively enrolled. Analysis is shown in the corresponding tables. Thirty eight percent (34/90) of patients deteriorated; 41% of those patients fully recovered back to their admission NIHSS and 32% experienced partial recovery. There were no differences in age, gender, admission NIHSS, or ethnicity between those who deteriorated and those who remained stable. Deteriorating patients were more likely to have received tPA, have a higher discharge NIHSS, and a higher 90 day mRS. Three quarters of the patients had deterioration within 24 hours of symptom onset. Of the deteriorating patients who initially received tPA, all worsened within 24 hours. Patients who deteriorated had a significantly higher incidence of mRS 3-6 compared to patients who remained stable. There were no associations between age, gender, or ethnicity with neurological recovery back to admission NIHSS in those patients who initially deteriorated.
Conclusion: This is the first prospective study to characterize the natural history of subcortical stroke fluctuation during hospitalization. Nearly 40% of all subcortical strokes patients deteriorated neurologically, but nearly 40% of those patients who deteriorated returned to their pre-deterioration status. Deterioration was associated with worse functional outcome at 90 days. Our study establishes a natural history template for designing future studies and identifies a subpopulation of patients for which new in-hospital therapies are needed to treat neurological deterioration in subcortical stroke.
- © 2012 by American Heart Association, Inc.