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Neurological deterioration in patients with acute ischemic stroke or transient ischemic attack


Park, Tai Hwan et al. (2021), Neurological deterioration in patients with acute ischemic stroke or transient ischemic attack, Dryad, Dataset,


Objective: To improve epidemiological knowledge of neurological deterioration (ND) in patients with acute ischemic stroke (AIS).

Methods: In this prospective observational study, we captured ND prospectively in 29,446 AIS patients admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurological symptoms. Change of incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) at 3 months and 1 year, and a composite of stroke, myocardial infarction and all-cause death at 1 year were assessed.

Results: ND occurred in 4299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence was within the first 6 hours which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, women, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, transient ischemic attack without a relevant lesion, steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%), followed by recurrence (8.5%). Adjusted relative risks (95% confidence interval) for poor outcome (mRS 3-6) at 3 months and one year were 1.75 (1.70-1.80), and 1.70 (1.65-1.75), respectively. The adjusted hazard ratio (95% confidence interval) for the composite event was 1.59 (1.45-1.74).

Conclusions: ND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.