Abstract 76: Genome Wide Association Study of Early Neurological Deterioration after Acute Ischemic Stroke Defines the Interferon-Stimulated Gene IFIT1 as a Neuroprotective Factor

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laura Heitsch ◽  
Andrew Kraft ◽  
Kristin Guilliams ◽  
Andria Ford ◽  
Naim Khoury ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pathway Analysis ◽  
Genome Wide Association Study ◽  
Stroke Onset ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Long Term Outcome ◽  
Genome Wide ◽  
Variant Analysis

Introduction: In the first hours after ischemic stroke, neurological deficits can be highly unstable. These early neurological changes are important due to their influence on long-term outcome. We performed a GWAS on ΔNIHSS 24h (NIHSS change from baseline to 24 hours after stroke onset) in acute ischemic stroke patients. Methods: DNA from 191 stroke patients presenting within 4.5 hours of stroke onset was genotyped using an Affymetrix Exome-chip. Single variant analysis was performed using PLINK, including age, baseline NIHSS and principal component factors as covariates. European- and African-Americans were analyzed separately, with p-values combined by meta-analysis. Gene-based analysis was performed using SKAT-O, including only non-synonymous variants. Pathway analysis was performed using ALIGATOR to identify pathways with SNPs with significant associations. IFIT1 -/- and IFIT1 +/+ mice underwent one-hour MCA occlusion (tMCAO) followed by 24-hour reperfusion. Brains were removed, TTC-stained, and infarcts measured. Results: Single variant analysis did not reveal genome-wide significant associations. One gene, IFIT1 (interferon-induced protein with tetratricopeptide repeats), passed the gene-based genome-wide multiple test correction (A). All three polymorphic variants in IFIT1 associated with neurologic deterioration with an average ΔNIHSS 24h 9.5 points lower in carriers versus non-carriers (B). Pathway analysis, including 21 interferon-related genes but excluding IFIT1 , showed a highly significant association (p=2.30х10 -3 ) with ΔNIHSS 24h. Infarct volumes in IFIT1 -/- mice were twice the size of IFIT1 +/+ mice after tMCAO (C, 110.6 mm 3 vs 52.8 mm 3 ). Conclusion: These data suggest that IFIT1 and other interferon-related genes may function in endogenous neuroprotective responses during acute ischemic stroke.

scholarly journals Multi-ancestry genetic study in 5,876 patients identifies an association between excitotoxic genes and early outcomes after acute ischemic stroke

2020 ◽  
Author(s):  
Laura Ibanez ◽  
Laura Heitsch ◽  
Caty Carrera ◽  
Fabiana H.G. Farias ◽  
Rajat Dhar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Genetic Study ◽  
Genetic Architecture ◽  
Stroke Onset ◽  
Neurological Deficits ◽  
European Ancestry ◽  
Genome Wide Association Studies ◽  
Synaptic Protein ◽  
Genome Wide

ABSTRACTDuring the first hours after stroke onset neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early neurological instability has a major impact on long-term outcome. Here, we aimed to determine the genetic architecture of early neurological instability measured by the difference between NIH stroke scale (NIHSS) within six hours of stroke onset and NIHSS at 24h (ΔNIHSS). A total of 5,876 individuals from seven countries (Spain, Finland, Poland, United States, Costa Rica, Mexico and Korea) were studied using a multi-ancestry meta-analyses. We found that 8.7% of ΔNIHSS variance was explained by common genetic variations, and also that early neurological instability has a different genetic architecture than that of stroke risk. Seven loci (2p25.1, 2q31.2, 2q33.3, 4q34.3, 5q33.2, 6q26 and 7p21.1) were genome-wide significant and explained 2.1% of the variability suggesting that additional variants influence early change in neurological deficits. We used functional genomics and bioinformatic annotation to identify the genes driving the association from each loci. eQTL mapping and SMR indicate that ADAM23 (log Bayes Factor (LBF)=6.34) was driving the association for 2q33.3. Gene based analyses suggested that GRIA1 (LBF=5.26), which is predominantly expressed in brain, is the gene driving the association for the 5q33.2 locus. These analyses also nominated PARK2 (LBF=5.30) and ABCB5 (LBF=5.70) for the 6q26 and 7p21.1 loci. Human brain single nuclei RNA-seq indicates that the gene expression of ADAM23 and GRIA1 is enriched in neurons. ADAM23, a pre-synaptic protein, and GRIA1, a protein subunit of the AMPA receptor, are part of a synaptic protein complex that modulates neuronal excitability. These data provides the first evidence in humans that excitotoxicity may contribute to early neurological instability after acute ischemic stroke.RESEARCH INTO CONTEXTEvidence before this studyNo previous genome-wide association studies have investigated the genetic architecture of early outcomes after ischemic stroke.Added Value of this studyThis is the first study that investigated genetic influences on early outcomes after ischemic stroke using a genome-wide approach, revealing seven genome-wide significant loci. A unique aspect of this genetic study is the inclusion of all of the major ethnicities by recruiting from participants throughout the world. Most genetic studies to date have been limited to populations of European ancestry.Implications of all available evidenceThe findings provide the first evidence that genes implicating excitotoxicity contribute to human acute ischemic stroke, and demonstrates proof of principle that GWAS of acute ischemic stroke patients can reveal mechanisms involved in ischemic brain injury.

Abstract WMP113: Genetic Influences on Early Neurological Instability After Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Laura Ibanez ◽  
Laura Heitsch ◽  
Caty Carrera ◽  
Israel Fernandez ◽  
Joan Montaner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Cohort Analysis ◽  
Neurological Deficits ◽  
Genetic Influences ◽  
Common Variants ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Genome Wide

Following acute ischemic stroke (AIS) onset, neurological deficits can be highly unstable. Early neurological change within the first 24 hours, defined here as ΔNIHSS24h (NIHSSbaseline-NIHSS24hours), substantially influences long-term outcome. While several mechanisms, such as hemorrhagic transformation and recanalization, may impact ΔNIHSS24h, little is known about genetic influences. Genetic variants associated with ΔNIHSS24h may identify genes involved in mechanisms of early neurological outcome after AIS. AIS patients were prospectively enrolled between 2008-2014 at two sites (St Louis and BCN; Table 1). NIHSS scores were obtained within 6 hours and again at 24 hours after stroke onset. Genome-wide genotyping was generated for rare and common variants, imputing up to 6 million single nucleotide polymorphisms (SNPs) for all subjects (N=891). ΔNIHSS24h was used as a quantitative trait to measure early improvement/deterioration. Genome-wide complex trait analysis (GCTA) was performed. An association model was done, using NIHSSbaseline, age, gender, glucose, PCA1 and PCA2 as covariates. All samples were analyzed together and then separately by ethnicity (Spanish, European-American (EA), and African-American (AA)). GCTA indicates that common variants account for 23-28% of ΔNIHSS24h variability. VAV3 rs72689643 (p=8.21x10-8) was associated with ΔNIHSS24h in the whole cohort analysis (Figure 1). Three additional suggestive SNPs were found: 2 intergenic SNPs (rs139950151 and rs73706194 - both p=6.1x10-7) in high LD and SNP rs10431426 (p=1.71x10-7) located in an intron. When analyzed by ethnicity, these findings did not reach GWAs significance, likely due to lack of power. Early neurological outcome after AIS is strongly influenced by genetics. Vav3 shows association with ΔNIHSS24h in the whole cohort while several other SNPs are suggestive. Rare variant analysis is underway, and we will also have an additional 800 genotypes analyzed by ISC.

scholarly journals Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2221
Author(s):  
Byron R. Spencer ◽  
Omar M. Khan ◽  
Bentley J. Bobrow ◽  
Bart M. Demaerschalk
Keyword(s):  
Decision Making ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Field Assessment ◽  
Primary Stroke Center ◽  
Stroke Center

Background Emergency Medical Services (EMS) is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC) relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA). Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED) arrival, recordings of time of stroke onset, blood pressure (BP), heart rate (HR), cardiac rhythm, blood glucose (BG), Glasgow Coma Scale (GCS), Cincinnati Stroke Scale (CSS) elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared to be very good overall. Diagnostic accuracy was excellent, field assessment, decision-making, and transport times were very good. There was still room for improvement in documentation of stroke onset and in employment of a common term for acute stroke.

Serum omentin-1 is a novel biomarker for predicting the functional outcome of acute ischemic stroke patients

2018 ◽  
Vol 56 (2) ◽  
pp. 350-355 ◽  
Author(s):  
Tian Xu ◽  
Peng Zuo ◽  
Yuqin Wang ◽  
Zhiwei Gao ◽  
Kaifu Ke
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Logistic Model ◽  
Critical Role ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Multivariable Logistic Regression Model ◽  
Poor Functional Outcome

Abstract Background: Recent studies have suggested that omentin-1 plays a critical role in the development of cardiovascular disease. However, reported findings are inconsistent, and no study has evaluated the association between omentin-1 levels and a poor functional outcome after ischemic stroke onset. Methods: A total of 266 acute ischemic stroke patients were included in this study. All patients were prospectively followed up for 3 months after acute ischemic stroke onset and a poor functional outcome was defined as a major disability or death occurring during the follow-up period. A multivariable logistic model was used to evaluate the association between serum omentin-1 levels and the functional outcome of ischemic stroke patients at 3 months. Results: Ischemic stroke patients with poor functional outcome had significantly lower levels of serum omentin-1 than patients without poor functional outcome at the 3-month follow-up (50.2 [40.2–59.8] vs. 58.3 [44.9–69.6] ng/mL, p<0.01). Subjects in the highest tertile of serum omentin-1 levels had a 0.38-fold risk of having poor functional outcome, compared with those in the lowest tertile (p<0.05). A negative association between omentin-1 levels and poor functional outcome was found (p for trend=0.02). The net reclassification index was significantly improved in predicting poor functional outcome when omentin-1 data was added to the multivariable logistic regression model. Conclusions: Higher omentin-1 levels at baseline were negatively associated with poor functional outcome among ischemic stroke patients. Omentin-1 may represent a biomarker for predicting poor functional outcome of acute ischemic stroke patients.

Abstract WMP120: Pre-stroke Statin Enhancement of Collateralization in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mengmeng Ma ◽  
Jiaying Zhu ◽  
Li He
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Statin Use

Background: Recent studies suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcome in case of stroke onset. It was speculated that pre-stroke statin may enhance collateral circulation and result in favorable functional outcome. This study aimed to investigate the association of pre-stroke statin use with leptomeningeal collaterals in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 hours from May 2011 to April 2017. CTA imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; admission NIHSS was used to measure stroke severity; modified Rankin scale (mRS) at 90 day was used to measure outcome. Univariate and multivariate analyses were performed. Results: 239 patients met inclusion criteria. 54 patients use statin before stroke onset. Pre-stroke statin use was independently associated with good collateral circulations (rLMCS>10) (OR, 4.786; 95% CI, 1.195 - 19.171; P = 0.027). Pre-stroke statin use was not independently associated with lower stroke severity (NIHSS≤14) (OR, 1.955; 95%CI, 0.657- 5.816; P = 0.228), but pre-stroke statin use was independently associated with good outcome (mRS≤2) (OR, 3.868; 95%CI, 1.325 - 11.289; P = 0.013). Conclusion: Pre-stroke statin use seems enhance collateralization and improve clinical outcomes in patients with acute stroke. However, clinical controlled studies should be used to verify this claim.

scholarly journals Higher fasting C-peptide is associated with post-stroke depression: a multicenter prospective cohort study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanyan Wang ◽  
Wenzhe Sun ◽  
Jinfeng Miao ◽  
Xiuli Qiu ◽  
Yan Lan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rating Scale ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Stroke Onset ◽  
Stroke Patients ◽  
C Peptide ◽  
Post Stroke ◽  
Post Stroke Depression

Abstract Background Fasting C-peptide (FCP) has been shown to play an important role in the pathophysiology of mood disorders including depression and schizophrenia, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between FCP and PSD at 6 months after acute ischemic-stroke onset among Chinese subjects. Methods A total of 656 stroke patients were consecutively recruited from three hospitals of Wuhan city, Hubei province. Clinical and laboratory data were collected on admission. PSD status was evaluated by DSM-V criteria and 17-item Hamilton Rating Scale for Depression (HAMD-17) at 6 months after acute ischemic stroke. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance. Multivariate logistic regression model was used to explore independent predictor of PSD. Results In the univariate analysis, significant differences were found between the PSD and non-PSD groups in terms of FCP level (p = 0.009). After multivariate adjustments, FCP remained a significant independent predictor of PSD, with an adjusted odds ratio of 1.179 (95%CI: 1.040–1.337, p = 0.010). Conclusions Higher FCP levels on admission were found to be associated with PSD at 6 months after acute ischemic-stroke onset. For stroke patients, doctors should pay attention to the baseline FCP for screening high-risk PSD in clinical practice.

scholarly journals One-Year Systolic Blood Pressure Trajectory After Acute Ischemic Stroke

2021 ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Adverse Outcomes ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
One Year

Abstract Although the effect of blood pressure on post-stroke outcome is well-recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not yet been fully elucidated. From a multicenter prospective registry of acute ischemic stroke patients, 5,514 patients with measurements of systolic blood pressure (SBP) at more than 2 of 7 prespecified time-points, up to 1-year after stroke onset, were analyzed. Outcome measures, a composite of stroke recurrence, myocardial infarction and mortality, and each stroke recurrence and mortality, were prospectively collected up to 1-year after stroke onset. The study subjects were categorized into 4 groups according to their SBP trajectories: Low (27.0%), Moderate (59.5%), Persistently high (1.2%), and Slowly dropping (12.4%). After adjustments for pre-determined covariates, the Slowly dropping SBP Group was at higher risk of the composite outcome (hazard ratio, 1.32; 95% confidence interval, 1.05‒1.65), and mortality (1.35; 1.03‒1.78) compared to the Moderate SBP Group. Four main 1-year longitudinal SBP trajectories were identified after acute ischemic stroke. One trajectory, slowly dropping SBP, was particularly prone to adverse outcomes after stroke. These findings provide possible leads for future investigations of SBP control targets after stroke.

Abstract 59: Extending the Time for Thombolysis in Emergency Neurological Deficits (EXTEND) - High Prevalence of Intracranial Vessel Occlusion in Wake-up-stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Henry Ma ◽  
Bruce C Campbell ◽  
Mark W Parsons ◽  
Christopher Levi ◽  
Atte Meretoja ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Stroke Onset ◽  
Phase Iii ◽  
Neurological Deficits ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Intracranial Vessel ◽  
Ct Angiogram

Background: EXTEND is an investigator-initiated, randomised, double-blind and placebo-controlled Phase III trial of intravenous alteplase vs placebo in patients with ischemic stroke 4.5-9 hours from stroke onset or wake-up-stroke (WUS). The prevalence of intra-cranial vessel occlusion in WUS patients remains to be determined and can guide the development of optimal therapy for this unique group of stroke patients. Objective: To study the prevalence and characteristics of intra-cranial vessel occlusion in this WUS cohort. Methods: Ischemic stroke patients within 4.5-9 hours from stroke onset or with WUS (time of WUS onset defined as the midpoint between time to sleep and awakening with the stroke symptoms) are eligible for enrollment. Criteria for entry into the trial include perfusion-diffusion mismatch using a perfusion threshold of Tmax>6sec and a perfusion:diffusion lesion volume ratio of >1.2. Diffusion lesion volume must be <70mL based on assessment by automated RAPID software. Intra-cranial vessel occlusion was assessed on MR or CT angiogram performed at randomisation and 24 later. Two expert readers assessed these images independently. Results: 97 patients had images with adequate quality, including 63 (65%) in the WUS group with median age of 77.0 yrs (IQR 67.0, 81.0) and NIHSS of 14.0 (9.0, 19.0). 62 of 63 patients (98%) had vessel occlusion with 44.4% involving M1 of the middle cerebral artery, 17.5% M2, 4.8% M3, 25.4% both internal carotid artery (ICA) and M1, 4.8% ICA alone and 3.1% the posterior cerebral artery. The median ischemic core volume was 15.0 ml (6.5, 31.5), Tmax>6 volume 88.5ml (58.0, 122.0), mismatch volume 65.5ml (42.8, 92.0), and ratio of 4.8 (2.5, 8.7). 19 patients (30%) demonstrated recanalization on follow-up imaging. Conclusion: In WUS patients there is a very high rate of intracranial vessel occlusion with relatively large volumes of salvageable penumbral tissue. Intravenous thrombolytic therapy followed by thrombectomy in selected cases may be an appropriate therapeutic option with safety and efficacy remaining to be established in randomized controlled trials.

Abstract WP142: Low Risk Of Posterior Circulation Stroke In Ischemic Stroke Patients With Vertebral Artery Ositium Stenosis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Seung Hoon Song ◽  
Joon Hwa Lee ◽  
So Young Moon ◽  
Hahn Young Kim
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Posterior Circulation ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Angioplasty And Stenting

Backgrounds Atherosclerosis of vertebrobasilar artery is a major cause of the ischemic stroke in the posterior circulation. Vertebral artery ostium stenosis (VAOS) is occasionally observed in patients with acute ischemic stroke in anterior or posterior circulation. However, VAOS as a risk for stroke recurrence, especially for the posterior circulation stroke, has not been well studied. This study was performed to determine long-term outcome and clinical significance of VAOS in acute ischemic stroke patients. Methods As a prospective observational study of single stroke center registry, we studied risk of recurrent stroke and vascular outcome in acute ischemic stroke patients with VAOS, recruited consecutively from December 2007 to December 2010. VAOS was defined as more than 50% stenosis of either vertebral artery ostium on a contrast-enhanced MRA. Vascular risk factors and long-term outcome including recurrent stroke, cardiovascular event, vascular mortality, or all-cause mortality were investigated. Results Of 773 acute ischemic stroke patients, underwent contrast-enhanced MRA, 149 (19.2%) had more than 50% VAOS (age, 70±10 years). All patients had intensive medical treatment and 11 patients underwent angioplasty and stenting. During 327 patient-years of follow-up (mean, 2.2 years), there were 8 ischemic (3 in posterior circulation, 5 in anterior circulation), 5 hemorrhagic, and 2 unknown stroke. The annual rate of events were 1.36% for posterior circulation ischemic stroke, 3.64% for all ischemic stroke, 5.91% for all stroke, 1.36% for vascular death, and 9.55% for all cause mortality. Symptomatic VAOS, concomitant stenosis of other vertebrobasilar arteries or carotid arteries, or stroke subtype was not associated with long-term outcome. Conclusions Long-term outcome of acute ischemic stroke patients with more than 50% VAOS was favorable on intensive medical treatment and selective angioplasty and stenting. Vertebral artery ostium stenosis may not be a major risk factor for the recurrent ischemic stroke in the posterior circulation.

scholarly journals National Institutes of Health Stroke Scale Zero Strokes

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3057-3059
Author(s):  
Elissavet Eskioglou ◽  
Mitra Huchmandzadeh Millotte ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Significant Proportion ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Recurrence Rates ◽  
Long Term Outcome

Background and Purpose— We aimed to characterize acute ischemic stroke patients who have an immeasurable deficit on the admission National Institutes of Health Stroke Scale (NIHSS), and to evaluate their long-term outcome. Methods— We retrospectively compared all acute ischemic stroke patients with an admission NIHSS of 0 in the Acute Stroke Registry and Analysis of Lausanne from 2003 to 2013 with all other acute ischemic stroke patients. We compared demographics, clinical, radiological, and laboratory findings. Outcome was considered favorable at 3 months if the modified Rankin Scale score corrected for prestroke disability was ≤1. Stroke recurrences >12 months were also assessed. Results— Comparing 108 NIHSS zero (NIHSS=0) patients with the 2889 other strokes by multivariate analysis, NIHSS=0 had lower prestroke disability, longer onset-to-hospital delays and more lacunar and infratentorial strokes. NIHSS=0 patients were less likely to have early ischemic changes on acute computed tomography, had less arterial pathology and lower creatinine levels. They were more likely to have favorable modified Rankin Scale score after correction for prestroke modified Rankin Scale score (zero versus others: 83.2% versus 44.6%) and less likely to die (3.9% versus 13.3%) at 12 months. Stroke and transient ischemic attack recurrence rates were similar (11% versus 11.4%), however. Conclusions— Patients with NIHSS=0 strokes are characterized by lacunar and infrantentorial strokes, normal acute computed tomography, and less arterial pathology. However, a significant proportion face recurrent ischemic events and persistent handicap at 12 months. Therefore, NIHSS=0 stroke patients require aggressive secondary prevention and adequate follow-up.

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