Abstract T P65: Early Statin Intervention Can Reduce the Early Neurological Deterioration and Recurrence in Acute Lacunar Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kazuki Fukuma
Keyword(s):  
Univariate Analysis ◽  
Patient Characteristics ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Lacunar Infarction ◽  
Lacunar Stroke ◽  
Factors Associated ◽  
Randomized Controlled ◽  
Early Neurological Deterioration ◽  
Statin Dose

Background and Purpose: Some patients with lacunar infarction show clinical neurological deterioration within few days after the onset. However factors associated with progressive lacunar stroke are unclear. The aim of this study was to identify the factors related to early neurological deterioration and recurrence in acute lacunar stroke. Methods: We studied 277 consecutive patients (173 men; mean age, 72 years) with a lacunar infarction admitted within 72 hours after the onset between Jan 2011 and Jul 2013. Progressive infarction (PI) was defined as an increase of ≥ 4 points in the National Institutes of Health Stroke Scale (NIHSS) score or recurrence of symptomatic ischemic stroke within 30 days after the onset. Associations between PI and patient characteristics, neuroimaging and acute treatments were evaluated. Results: Twenty-four of the 277 patients (8.7%) had PI, 21 patients (7.6%) presented with neurological deterioration and remaining 3 (1.1%) with symptomatic recurrence. In univariate analysis, an initial infarct extent of ≥15 mm was more frequent (P < 0.01), and age (P = 0.04), CRP (P = 0.05) and LDL-C (P = 0.04) were higher in patients with PI than those without. Early statin intervention (newly initiated statin, dose-escalation of pre-treated statin, or switching to strong statin) was significantly more frequent in patient without PI (41.9 vs 20.8%, P=0.04). Early dual antiplatelet or anticoagulant therapy was not associated with PI. In multivariate analysis, age [OR: 1.67 per 10 year; 95% CI: 1.07-2.70, p = 0.02], an initial infarct extent of ≥15 mm [OR: 5.26; 95% CI: 2.01-14.37, p < 0.01], LDL-C [OR: 1.25 per 10mg/dL; 95% CI: 1.09-1.46, p < 0.01], and statin intervention [OR: 0.22; 95% CI: 0.06-0.68, p < 0.01] were related to PI. Conclusion: Older Age, higher LDL-C and larger initial infarct extent were related to early neurological deterioration and recurrence in acute lacunar stroke. Further, early statin intervention can reduce the progressive lacunar stroke. Prospective randomized controlled trials are needed to determine whether the early statin intervention can prevent progression in acute lacunar stroke.

Impact of Brain Atrophy on Early Neurological Deterioration and Outcome in Severe Ischemic Stroke Treated by Intravenous Thrombolysis

2018 ◽  
Vol 79 (5-6) ◽  
pp. 240-246 ◽  
Author(s):  
Olivier Tschirret ◽  
Gabriela Moreno Legast ◽  
Adeline Mansuy ◽  
Nathan Mewton ◽  
Marielle Buisson ◽  
...  
Keyword(s):  
Brain Atrophy ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Good Outcome ◽  
Early Neurological Deterioration ◽  
Backward Procedure ◽  
Proximal Occlusion

Background: Brain atrophy has shown a protective effect on the risk of early neurological deterioration (END) related to malignant edema in patients with hemispheric infarction but could be deleterious on the outcome. Aims: We aimed to assess whether brain atrophy has an impact on the risk of END and on the outcome in severe ischemic strokes after intravenous (IV) thrombolysis. Methods: From a prospective thrombolysis registry, 137 patients who had a National Institutes of Health Stroke Scale (NIHSS) ≥15, MRI at admission, and IV thrombolysis were included. Relative cerebral volume was calculated. END was defined as a ≥2-points deterioration 72-h NIHSS and a good outcome as a modified Rankin Scale (mRS) ≤2 at 3 months. A multiple logistic regression analysis with a stepwise backward procedure was performed. Results: END and a good outcome were observed, respectively, in 20 (14.6%) and 48 (37.5%) patients. In univariate analysis, predictors of END included age (p = 0.049), diabetes (p = 0.041), and parenchymal hemorrhage (p = 0.039). In multivariate analysis, age (p = 0.018) was significantly associated with END. Brain atrophy was not associated with END even in subgroup analysis according to the baseline infarct size. In univariate analysis, age (p = 0.003), prestroke mRS (p = 0.002), hypertension (p = 0.006), baseline NIHSS (p = 0.002), END (p = 0.002), proximal occlusion (p = 0.006), and recanalization at 24 h (p < 0.001) were associated with a good outcome. Only baseline NIHSS (p = 0.006) was associated with a good outcome after adjustment. Conclusions: We did not find any impact of brain atrophy on the risk of END and the outcome at 3 months in severe ischemic strokes after IV thrombolysis.

Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction

2017 ◽  
Vol 79 (1-2) ◽  
pp. 54-62 ◽  
Author(s):  
Huimin Fan ◽  
Shuna Yang ◽  
Yue Li ◽  
Jiangmei Yin ◽  
Wei Qin ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Prognostic Biomarker ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
National Institutes Of Health ◽  
Lacunar Infarction ◽  
Control Group ◽  
Clinical Predictors ◽  
Receiver Operating Characteristic Curves ◽  
Early Neurological Deterioration

Background: Although increasing evidence has demonstrated that elevated homocysteine (Hcy) levels may be an important contributor for the development of cerebral infarction, rare studies focused on its diagnostic and early prognostic roles in acute lacunar infarction. Methods: A total of 197 patients with acute lacunar infarction and 192 to form the control group were prospectively recruited between January 2013 and February 2017. Early neurological deterioration was defined as an increase of ≥2 points in National Institutes of Health Stroke Scale or the decrease in Barthel index (BI) score at discharge. Results: Univariate and multivariate logistic regression analyses revealed that higher levels of fibrinogen and Hcy were independently clinical predictors associated with lacunar infarction. Receiver operating characteristic curves analysis demonstrated that the diagnosis value of Hcy was superior to fibrinogen, with the area under the curve of 0.881 and 0.688 respectively. Using the optimal cutoff value of 15.5 μmol/L of Hcy, a sensitivity of 65% and a specificity of 100% were achieved for predicting lacunar infarction. Hcy was only significantly related with BI reduction in the males (30.5 [15.5–65.5] vs. 18 [15–24], p = 0.034) in the univariate analysis but not in the females and the multivariate analysis. Conclusions: Serum Hcy may be an independent diagnostic and not an early prognostic biomarker for patients with acute lacunar infarction.

Using population-based routinely collected data from the Sentinel Stroke National Audit Programme to investigate factors associated with discharge to care home after rehabilitation

2017 ◽  
Vol 32 (8) ◽  
pp. 1108-1118 ◽  
Author(s):  
Dipankar Dutta ◽  
Daniel Thornton ◽  
Emily Bowen
Keyword(s):  
Care Home ◽  
Univariate Analysis ◽  
Population Based ◽  
National Institutes Of Health ◽  
National Audit ◽  
Factors Associated ◽  
Routinely Collected Data ◽  
Early Supported Discharge ◽  
Research Findings ◽  
First Time

Objectives: We investigated factors associated with Care Home (CH) discharge following stroke using routinely collected data in unselected patients and assessed the relevance of previous research findings to such patients seen in routine clinical practice. Design: Retrospective analysis of data from the Sentinel Stroke National Audit Programme using univariate analysis and logistic regression. Setting: A large acute and rehabilitation UK stroke unit with access to early supported discharge. Subjects: All patients with stroke treated from 1 January 2014 to 1 January 2017. Main measures: National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results: Of 2584 patients (median age 78 years, interquartile range (IQR) 69–86; 50.6% male; 86.7% infarcts; median admission NIHSS 4, IQR 2–9), 401 (15.5%) died in hospital and 203 patients (7.9%) were permanently discharged to CH for the first time. Most had pre-discharge mRS scores of 4/5. Factors (odds ratios; 95% confidence intervals) associated with CH discharge included age (1.07; 1.05–1.10), incontinence (11.5; 7.13–19.25), dysphagia (2.13; 1.39–3.29), severe weakness (1.93; 1.28–2.92), pneumonia (1.68; 1.13–2.50), urinary tract infection (UTI) (1.70; 1.04–2.75) and depression (1.65; 1.00–2.72). In a subgroup of all patients with a pre-discharge mRS of 4/5, age (1.04; 1.02–1.06), incontinence (4.87; 2.39–11.02), UTI (2.0; 1.09–3.71) and pneumonia (1.59; 1.02–2.50) were the only factors associated with CH discharge. Conclusion: Potentially modifiable variables like incontinence, UTI and pneumonia were associated with CH discharge, particularly in the severely disabled.

scholarly journals Predictors and Outcomes of Neurological Deterioration in Intracerebral Hemorrhage: Results from the TICH-2 Randomized Controlled Trial

2020 ◽  
Author(s):  
Zhe Kang Law ◽  
◽  
Rob Dineen ◽  
Timothy J England ◽  
Lesley Cala ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Controlled Trial ◽  
Neurological Deterioration ◽  
Unique Identifier ◽  
Risk Of Death ◽  
Randomized Controlled ◽  
Early Neurological Deterioration ◽  
The Uk

Abstract Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70–6.70; p < 0.001). Tranexamic acid reduced the risk of early (aOR 0.79, 0.63–0.99; p = 0.041) but not late neurological deterioration (aOR 0.76, 0.52–1.11; p = 0.15). Larger hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL:https://www.isrctn.com Unique identifier: ISRCTN93732214

Early neurological deterioration represents recurrent attack in acute small non-lacunar stroke

2004 ◽  
Vol 217 (2) ◽  
pp. 151-155 ◽  
Author(s):  
Noriko Matsumoto ◽  
Kazumi Kimura ◽  
Chiaki Yokota ◽  
Kiminobu Yonemura ◽  
Kuniyasu Wada ◽  
...  
Keyword(s):  
Neurological Deterioration ◽  
Lacunar Stroke ◽  
Recurrent Attack ◽  
Early Neurological Deterioration

Abstract WP251: Sleep Apnea and Early Neurological Deterioration in Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cindy W Yoon ◽  
Joung-Ho Rha ◽  
Hee-Kwon Park
Keyword(s):  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Apnea Hypopnea Index ◽  
Early Neurological Deterioration ◽  
Multivariable Regression ◽  
The Impact

Background and Purpose: Evidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. Methods: We prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink - a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of ≥ 5/hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by ≥ 1 point in motor power, or ≥ 2 points in the total score within the first week after admission. Results: Of the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5/hour), and of these, 114 (37.4%) had mild SA (AHI 5-14/hour), 59 (19.3%) had moderate SA (AHI 15-29/hour), and 81 (26.6%) had severe SA (AHI ≥ 30/hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; p = 0.008). Conclusions: SA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.

Performance of automated single-lead ECG atrial fibrillation screening is associated with patient characteristics

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
MD Zink ◽  
B Freedman ◽  
K Mischke ◽  
A Keszei ◽  
C Rummey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Automatic Measurement ◽  
Patient Characteristics ◽  
Receiver Operating Curve ◽  
Signal Quality ◽  
Good Prediction ◽  
Factors Associated

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The investigators received and unrestricted research grant by Pfizer/BMS. Pfizer/BMS was not involved in the planning, conduction, analysis, or interpretation of the data. Introduction Screening for atrial fibrillation (AF) with a single-lead electrocardiogram device is on the rise. However, little is known about influence of automated AF screening performance related to patient characteristics. Aim We tested the accuracy of automated AF detection of a single-lead ECG device and identified factors associated with diagnostic performance. Methods In 6482 subjects of community-pharmacies a single-time point AF screening was performed. All ECGs were analyzed by blinded human overread and compared to the automated results in context of patient characteristics. Results Automated screening showed good prediction of AF with an area under the receiver operating curve of 0.89; sensitivity 80%; specificity 98%; positive predictive value 71%; negative predictive value 99%. Good ECG signal quality was highly associated with correct measurement, while low signal quality leads to incorrect measurements. In a multivariate model we determined factors associated with excellent signal quality and as counterexample incorrect automatic AF identification. The Odds’ ratio (OR) for excellent signal quality was strongly associated with female sex, lower age, lower height, and higher body weight index (table). Conclusion The performance of automated AF screening is influenced by sex, age, height and body mass index. Potential target population groups, with high AF prevalence, have a higher chance of incorrect automatic measurement. We recommend an expert over-read, at least for all AF positive ECG recordings. Table 1 Excellent signal quality Incorrect measurement Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis Parameter OR 95% CI P OR 95% CI P OR 95% CI P OR 95% CI P Sex [Female] 2.33 1.97-2.75 &lt;0.001 1.92 1.53-2.41 &lt;0.001 0.64 0.49-0.84 0.001 0.57 0.43-0.76 &lt;0.001 Age [years] 0.97 0.96-0.98 &lt;0.001 0.97 0.96-0.98 &lt;0.001 1.07 1.04-1.09 &lt;0.001 1.06 1.04-1.09 &lt;0.001 Height [cm] 0.96 0.95-0.97 &lt;0.001 0.98 0.97-0.99 0.003 1.01 0.99-1.03 0.068 Weight [kg] 0.99 0.99-1.00 0.418 0.99 0.98-0.99 0.003 BMI [kg/cm2] 1.04 1.03-1.06 &lt;0.001 1.04 1.03-1.06 &lt;0.001 0.91 0.88-0.95 &lt;0.001 0.91 0.87-0.94 &lt;0.001 CHADSVASC 1 0.95-1.06 0.912 1.06 0.97-1.17 0.205 Heart failure 0.62 0.41-0.93 0.022 1.86 1.13-3.05 0.015 Hypertension 0.96 0.83-1.11 0.58 1.06 0.80-1.39 0.689 Diabetes mellitus 0.85 0.68-1.07 0.159 0.82 0.54-1.25 0.359 Stroke / TIA 0.82 0.66-1.01 0.066 1.19 0.83-1.69 0.341 Vascular disease 0.89 0.75-1.07 0.213 1.31 0.98-1.77 0.70 OR – odd’s ratio, CI – confidence interval

Clinical outcomes of patients with acute minor stroke receiving rescue IA therapy following early neurological deterioration

2015 ◽  
Vol 8 (5) ◽  
pp. 461-465 ◽  
Author(s):  
Joon-Tae Kim ◽  
Suk-Hee Heo ◽  
Woong Yoon ◽  
Kang-Ho Choi ◽  
Man-Seok Park ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
National Institutes Of Health ◽  
Neurological Deterioration ◽  
Favorable Outcome ◽  
Minor Stroke ◽  
Multivariate Logistic Regression ◽  
Full Data ◽  
Minor Ischemic Stroke ◽  
Early Neurological Deterioration

BackgroundPatients presenting with minor ischemic stroke frequently have early neurological deterioration (END) and poor final outcome. The optimal management of patients with END has not been determined.ObjectiveTo investigate rescue IA therapy (IAT) when patients with acute minor ischemic stroke develop END.MethodsThis was a retrospective study of consecutively registered patients with acute minor stroke and END. ‘END’ was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) scores by 1 or more points (or development of new neurological symptoms) and ‘ΔEND−NIHSS’ was defined as numerical difference between NIHSS scores at the time of END and before END. Rescue IAT following END was adjusted for the covariates to evaluate the association between IAT and favorable outcome at 3 months.ResultsAmong 982 patients with acute minor ischemic stroke, END occurred in 232 (23.6%). Of the 209 patients with END with full data available, 87 (41.6%) had favorable outcomes at 3 months. Rescue IAT following END was performed in 28 (13.4%). Favorable 3-month outcomes were seen in 50% of patients undergoing rescue IAT, including 8/19 (42.1%) undergoing rescue IAT beyond 8 h. By multivariate logistic regression analysis, rescue IAT following END was independently associated with favorable outcome at 3 months (OR=10.9; 95% CI 3.06 to 38.84; p<0.001).ConclusionsThe results suggest that rescue IAT may be safe and effective when END occurs in selected patients with acute minor ischemic stroke. Further prospective and randomized studies are needed to confirm our results.

scholarly journals Compressed Sensing Algorithm-Based Magnetic Resonance Imaging Guided for Prognosis of Early Neurological Deterioration after Intravenous Thrombolysis in Ischemic Stroke Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yiwei Huang ◽  
Xiaoyun Sun ◽  
Yinping Yao ◽  
Yejun Chen ◽  
Yan Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Resonance Imaging ◽  
Blood Cell Count ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Watershed Infarction

This work was aimed to study the risk factors and prognostic treatment for acute ischemic stroke (AIS) patients with early neurological deterioration (END) after intravenous thrombolytic therapy via compressed sensing algorithm-based magnetic resonance imaging (CS-MRI). 231 patients who were diagnosed with AIS were selected, and the final involved number of patients was 182. Patients with AIS were treated with intravenous thrombolysis with alteplase within 4.5 hours of onset. After treatment, patients with early neurological deterioration were defined as the deteriorating group and those without early neurological impairment were defined as the nondeteriorating group. In univariate analysis, hypertension, white blood cell count, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the occurrence of END. Under the CS-MRI theory, the two groups of patients were evaluated for middle cerebral artery basal ganglia infarction and internal watershed infarction. After univariate analysis, the P < 0.1 variables were taken as the independent variable, and the binary logistic regression model was adopted for multivariate regression analysis. It was disclosed that NIHSS score was not correlated with the occurrence of early neurological function deterioration, while homocysteine was. Hypertension, white blood cell count, homocysteine, and NIHSS score were risk factors for END. The image analysis revealed that the incidence of deteriorating basal ganglia infarction group was lower relative to the nondeteriorating group, and the incidence of watershed infarction was higher in the deteriorating group versus the nondeteriorating group. The image analysis suggested that predicting the occurrence of END through risk factors can actively provide endovascular treatment for patients with AIS.

scholarly journals Clinical and radiological factors predict unexplained early neurological deterioration after intravenous thrombolysis in patients with acute middle cerebral artery stroke

2019 ◽  
Author(s):  
Yiping Ding ◽  
Tong Sun ◽  
Yue Lu ◽  
Shuangjiao Huang ◽  
Shanshan Diao ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Neurological Deterioration ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Middle Cerebral Artery Stroke ◽  
Proximal Occlusion ◽  
Multimodal Ct

Abstract Background Some patients with acute middle cerebral artery stroke (MCA-stroke) cannot benefit from thrombolysis and develop early neurological deterioration (END) within 24 hours. Except for several defenitive causes such as symptomatic intracerebral hemorrhage, malignant edema, and early recurrent stroke, no definitive mechanism (unexplained END) account for majority of END cases deserving our attention. Methods We retrospectively collected 142 MCA-stroke patients who had pretreatment multimodal CT including non-contrast CT (NCCT), CT angiography (CTA) and CT perfusion (CTP) and received intravenous thrombolytic therapy within 4.5h of onset and. Unexplained END was denited as NIHSS scores increased from baseline within 24 hours after thrombolysis ≥ 4 points or death without definite causes. The clinical and imaging data based on multimodal CT were compared between unexplained END and no END through univariate and multivariate regression analyses. Results The prevalence of unexplained END (24 patients, 16.9%) outnumbered the prevalence of END due to other causes. Univariate analysis showed that higher admission glucose (P= 0.039), lower initial NIHSS score (P=0.026), lower r-LMC score (P= 0.003), proximal occlusion (P=0.003) and large penumbra volume(P<0.001) were more frequently observed in patients with unexplained END; In multivariate analysis, lower NIHSS score (OR=1.19; 95% CI, 1.07-1.32; P=0.001), proximal occlusion (OR=0.32; 95% CI, 0.06-0.92; P=0.038), lower r-LMC score (OR=1.17; 95% CI, 1.02-1.35; P=0.028) and larger penumbra volume (OR=0.98; 95% CI, 0.96-0.99; P=0.003) were associated with unexplained END. Conclusion Lower NIHSS score, proximal occlusion, lower r-LMC score and larger penumbra volume can predict unexplained END in the hyperacute phase of MCA-stroke and contribute to develop treatment strategies.

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