Abstract T MP77: Incidence of Neurofluctuation in Patients with Subcortical Ischemic Stroke - Results from a Prospective Cohort Study
Subcortical strokes (SCS) are associated with stroke progression. The primary objective was to assess the incidences of neurological deterioration and its spontaneous reversal in SCS patients. We also estimated the risk of poor outcome associated with deterioration.
Methodology: A prospective cohort of SCS patients was enrolled based on clinical exam and imaging studies, and was followed through the course of hospitalization. NIH stroke scale (NIHSS) assessments were performed daily and whenever symptoms worsened (increase of ≥ 1 in motor scale). Modified Rankin Scale (mRS) score at discharge was used to assess outcomes. Patients received standard of care stroke therapy including IV t-PA as per AHA guidelines, and episodes of deterioration were managed conservatively. The Anderson Gill Cox proportional hazard model was used to analyze factors associated with time to deterioration and spontaneous reversal. Log binomial regression was performed for estimation of risk of poor outcome.
Results: The cumulative incidence of deterioration was 43.3% and of those who deteriorated, spontaneous reversal occurred in 37.8%. The median time to deterioration was 21 hours from stroke onset. Use of IV t-PA was significantly associated with both deterioration (HR: 2.25, 95% CI: 1.13 - 4.49) (Figure 1a) and spontaneous reversal (HR: 4.36, 95% CI: 1.36 - 14.01) (Figure 1b). Deteriorated patients had a higher risk of poor discharge outcome (mRS ≥ 3) (RR: 1.80, 95% CI: 1.71 - 1.93), after adjusting for age, initial stroke severity, and use of IV t-PA.
Conclusion: The results from this study establish a natural history of neurofluctuation in patients with SCS. Our data suggests that deterioration occurs early in these patients, and only about a third of deteriorated patients reverse spontaneously. Furthermore, deterioration is associated with poor short term functional outcome. There is a need to develop and test novel therapies to treat neurological deterioration in SCS.
Author Disclosures: F.S. Vahidy: None. W.J. Hicks: None. I. Acosta: None. H. Hallevi: None. H. Peng: None. R. Pandurengan: None. N. Gonzales: None. A. Barreto: None. S. Martin-Schild: None. T. Wu: None. M.H. Rahbar: None. A. Bambhroliya: None. J.C. Grotta: None. S.I. Savitz: None.
- © 2014 by American Heart Association, Inc.