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QJM Advance Access published online on August 11, 2006
QJM, doi:10.1093/qjmed/hcl082
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: Journals.permissions@oxfordjournals.org
Received January 10, 2006
Accepted May 15, 2006

Original Papers

Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome

J. Kwan 1 * and P. Hand 2

1 From the Elderly Care Research Unit, Southampton General Hospital, Southampton, UK
2 From the Department of Neurology, Royal Melbourne Hospital, Parkville, Australia

* To whom correspondence should be addressed.
J. Kwan, E-mail: drjkwan{at}aol.com


  Abstract

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.


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Postgrad. Med. J., August 1, 2008; 84(994): 412 - 417.
[Abstract] [Full Text] [PDF]


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