QJM Advance Access originally published online on August 11, 2006
QJM 2006 99(9):625-633; doi:10.1093/qjmed/hcl082
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome
From the 1Elderly Care Research Unit, Southampton General Hospital, Southampton, UK and 2Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
Address correspondence to Dr J. Kwan, Elderly Care Research Unit, Level E (807), Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD. email: drjkwan{at}aol.com
Received 10 January 2006 and in revised form 15 May 2006
Background: A significant proportion of acute stroke patients suffer neurological deterioration during the first few days of recovery.
Aim: To explore the frequency, clinical characteristics, and consequences of early neurological deterioration during the acute recovery period.
Methods: We assessed all consecutive patients admitted to a University hospital with suspected stroke. We recorded the following on admission: baseline characteristics, physiological parameters and laboratory results. On day 5 we recorded occurrence of complications, and functional outcome. Early neurological deterioration was defined as an increase in National Institute of Health Stroke Score (NIHSS) by two or more points (or stroke-related death) between admission and day 5.
Results: We recruited 188 stroke patients, of whom 36 (19%) suffered early neurological deterioration. Patients with early neurological deterioration were significantly more likely to: (i) arrive at the hospital earlier (median 2.25 vs. 7.2 h, p = 0.015); (ii) have a history of atrial fibrillation (33% vs. 16%, p = 0.039); (iii) be current non-smokers (24% vs. 11%, p = 0.041); (iv) have a severe stroke—more total anterior circulation strokes (67% vs. 26%, p < 0.001) and worse NIHSS and GCS scores; (v) have intracerebral haemorrhage (22% vs. 7%, p = 0.011); (vi) have higher serum urea (mean 7.8 vs. 6.5 mmol/l, p = 0.035) and leukocyte count (mean 12.6 vs. 9.7 x 109/l, p = 0.044); and (vi) die in hospital (44% vs. 10%, OR 12.8, 95%CI 3.8–43.1, p < 0.001).
Discussion: Early neurological deterioration is a frequent and important complication in acute stroke, with a poor short-term prognosis. Effective treatment strategies are urgently needed to reduce its occurrence and impact on recovery.