Abstract TMP90: Frequency and Risk Factors for Early Neurological Deterioration Among Hyperacute Cerebral Ischemia Patients Treated With and Without Thrombolysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christa D Brown ◽  
Gilda Avila-Rinek ◽  
Nerses Sanossian ◽  
Sidney Starkman ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Ischemia ◽  
Fold Increase ◽  
Information Criteria ◽  
Neurological Deterioration ◽  
Stroke Severity ◽  
Acute Cerebral Ischemia ◽  
Early Neurological Deterioration ◽  
Prior Stroke ◽  
Iv Tpa

Background: Early neurological deterioration (END) is a feared complication of acute cerebral ischemia. However, estimates of END frequency vary widely, rates have not been systematically examined in hyperacute patients presenting within the first 2h of onset, nor separately in patients treated with and without thrombolysis, and risk factors for END have not been well delineated. Methods: We analyzed patients with a final diagnosis of acute cerebral ischemia in the NIH FAST-MAG Phase 3 multicenter clinical trial. END was defined as worsening post-admission by ≥ 4 NIHSS points up to Day 4. We separately analyzed patients who did and did not receive IV tPA. Results: Among 1245 acute cerebral ischemia patients transported by EMS to 55 stroke centers, time from last known well (LKW) to ED arrival was median 59 mins (IQR 80-46), and 36.1% received IV tPA. Overall, 211 (16.9%) experienced END by Day 4, with a greater proportion of END in tPA than non-tPA patients (21.2% vs 14.5%, p=0.003). In multivariate analysis, from 26 candidate variables, among tPA recipients, independent predictors of END were: age (OR 1.03/year, 95%CI 1.01-1.05), diastolic BP (OR 1.01/mm Hg, 95%CI 1.00-1.03), prior stroke (OR 1.65, 95%CI 0.98-2.77), glucose (OR 11.06/10 fold increase, 95%CI 1.90-64.44), and worse ASPECTS score (OR 0.85/point, 95%CI 0.78-0.92). Among non-tPA recipients, independent predictors of END were: more severe NIHSS (OR 1.08/point, 95%CI 1.05-1.11), glucose (OR 8.88/10 fold increase, 95%CI 1.83-43.12), and h/o hypertension (OR 2.62/mm Hg, 95%CI 1.25-5.48), with Akaike information criteria identifying SBP, shorter LKW-to-ED time, and absence of anticoagulant agents as additional contributors. C statistics for these models were 0.68 for tPA patients and 0.73 for non-tPA patients. Conclusions: Among hyperacute cerebral ischemia patients, END occurs in 1 in 5 who receive tPA, and 1 in 7 who do not receive tPA. Greater initial stroke severity (on neurologic exam or imaging), higher glucose, and hypertension increase risk of END for both lytic and non-lytic patients, with older age and prior stroke additionally increasing END risk with tPA. Models based on these risk factors show fair to good performance identifying patients who will experience END after hospital admission.

Abstract 6: Frequency, Risk Factors, Causes, and Outcomes of Early Neurological Deterioration in Hyperacute Cerebral Ischemia

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Christa D Brown ◽  
Gilda Avila-Rinek ◽  
Nerses Sanossian ◽  
Sidney Starkman ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Ischemia ◽  
Neurological Deterioration ◽  
Early Neurological Deterioration

Abstract TP233: Patterns, Determinants and Outcomes of Ultra-Early Neurological Deterioration (U-END) in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kristina Shkirkova ◽  
Gregory Wong ◽  
Julius Weng ◽  
Jeffrey L Saver ◽  
Sidney Starkman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Ischemia ◽  
Management Strategies ◽  
Neurological Deterioration ◽  
Effective Management ◽  
Stroke Therapy ◽  
Phase 3 ◽  
Prehospital Treatment ◽  
Acute Cerebral Ischemia ◽  
Early Neurological Deterioration

Background: The patterns and outcomes of deterioration during prehospital transport and the first phase of ED care are important for planning for diversion of acute cerebral ischemia (ACI) patients to designated stroke centers and design of prehospital treatment trials. Methods: We analyzed patients enrolled in the NIH Phase 3 Field Administration of Stroke Therapy - Magnesium (FAST-MAG) trial within 2h of last known well (LKW). Deterioration was defined as worsening by ≥2 on the Glasgow Coma Scale (GCS), performed serially by paramedics in the field, upon ED arrival, and after the early ED course. Results: Among 713 acute cerebral ischemia patients, age was 65.4 (±13.4), 45% female. Times from LKW to GCS assessments were: paramedic, 25 mins (IQR 15-46); ED arrival, 60 mins (IQR 48-82); and after early ED course, 83 mins (IQR 60-106). Overall, 16.3% experienced neurological deterioration, including 9.0% in prehospital phase only, 7.3% in early ED phase only, and none in both phases. Granular patterns of deficit progression were: Prehospital Sustained - prehospital deterioration, then stable early ED phase, 2.2% (16); Dippers - prehospital deterioration, then early ED improvement, 6.7% (48); Delayed - stable prehospital, then ED deterioration, 3.0% (22); and Peakers - prehospital improvement, then early ED deterioration, 4.2% (30) (Figure). Ischemic stroke patients who experienced any U-END had higher age, 73.2 vs 69.8, p<0.01; lower prehospital GCS scores, 14 (IQR 11-15) vs 15 (IQR 14-15), p<0.001; and greater prehospital focal weakness, LAMS 4.2 vs 3.6, p<0.001. U-END was associated with higher rates of disability or death (mRS 2-6) at 90 days, 77.8% vs 53.8%, p<0.001. Conclusions: Ultra-early neurological deterioration occurs in one-sixth of EMS-transported acute cerebral ischemia patients, and is associated with less favorable outcome. Early identification and effective management strategies are needed to reduce its occurrence.

scholarly journals High neutrophil-to-lymphocyte ratio predicts early neurological deterioration in spontaneous intracerebral hemorrhage patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Wafaa S. Mohamed ◽  
Amr E. Kamel ◽  
Ahmed H. Abdelwahab ◽  
Mohamed E. Mahdy
Keyword(s):  
Intracerebral Hemorrhage ◽  
Complete Blood Count ◽  
Absolute Lymphocyte Count ◽  
Neurological Deterioration ◽  
University Hospital ◽  
Stroke Severity ◽  
Low Grade ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Gcs Score

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

Abstract 120: A Multicenter Study of the Prevalence and Outcomes of Intracranial Large Artery Atherosclerosis among Stroke and TIA Patients in China

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yongjun Wang ◽  
Liping Liu ◽  
Yilong Wong ◽  
Yannie Soo ◽  
Yuehua Pu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Ischemia ◽  
Multicenter Study ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Arterial Stenosis ◽  
Hospital Treatment ◽  
Large Artery ◽  
Acute Cerebral Ischemia ◽  
History Of

BACKGROUND The prevalence, characteristics and outcomes of stroke patients with intracranial large artery atherosclerosis have not been clearly established by large multicenter prospective study. METHODS In this prospective multicenter study, we evaluated 2864 consecutive patients (mean age, 62 years) who experienced an acute cerebral ischemia, including ischemic stroke or transient ischemic attack (TIA), within 7 days of symptom onset in 22 hospitals in China. All patients underwent magnetic resonance angiography (MRA), with measurement of diameter of the main intracranial arteries. Intracranial large artery atherosclerosis was defined as at least 50% diameter reduction on MRA. RESULTS The prevalence of intracranial stenosis was 46.6% (1,335 patients, including 261 patients with co-existing extracranial carotid stenosis). Patients with intracranial stenosis had more severe stroke at admission and stayed longer in hospitals than those without intracranial stenosis (median NIHSS 3 vs 5, ; median length of stay 14 vs 16 days respectively, both p<.0001). In hospital treatment included antithrombotics (96%), statins (76%), and antihypertensives (51%). After 12 months, recurrent stroke occurred in 3.34% of patients with no stenosis, 3.82% for 50-69% stenosis, 5.16% for 70-99% stenosis and 7.40% for 100% occlusion. Apart from the degree of arterial stenosis, age, family history of stroke, prior history of cerebral ischemia or heart disease and no prior use of antithrombotic drug were independent risk factors for recurrent stroke. The recurrent rate of each group of patients categorized by degree of stenosis and number of risk factor is shown in the Figure . The highest rate of recurrence was observed in patients with 100% occlusion with the presence of 3 additional risk factors. CONCLUSION Intracranial large artery stenosis is the commonest vascular lesion in patients with cerebrovascular disease in China. Recurrent stroke rates remains high in patients with severe stenosis and other risk factors despite prevalent use of medical treatment such as antiplatelet, antihypertensive and statin therapies.

Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage

2008 ◽  
Vol 109 (6) ◽  
pp. 1052-1059 ◽  
Author(s):  
J. Michael Schmidt ◽  
Katja E. Wartenberg ◽  
Andres Fernandez ◽  
Jan Claassen ◽  
Fred Rincon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Cerebral Infarction ◽  
Clinical Symptoms ◽  
External Ventricular Drain ◽  
Delayed Cerebral Ischemia ◽  
Neurological Deterioration ◽  
Modified Rankin Scale ◽  
Poor Grade

Object The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). Methods The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale. Results Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017). Conclusions Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.

Abstract TP231: Predictors of Early Neurological Deterioration in Acute Minor Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sang Min Sung ◽  
Yoon Jung Kang ◽  
Sung Hwan Jang ◽  
Nae Ri Kim ◽  
Suk Min Lee
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Vascular Diseases ◽  
Hemorrhagic Transformation ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Minor Ischemic Stroke ◽  
Early Neurological Deterioration

Introduction: Early neurological deterioration is one of the critical determinants of functional outcomes in patients with minor ischemic stroke. The purpose of this study was to identify predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients with acute minor ischemic stroke who are admitted within 24 hours after onset of stroke symptom between January 2014 and December 2018 were enrolled in this study. We analyzed demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, neuroimaging parameters, and relevant arterial steno-occlusive lesions. Early neurological deterioration was defined as any worsening of neurological deficits within 3 days after admission. Logistic regression was used to determine independent predictors of early neurological deterioration. Results: Seventy-eight of 739 (10.5%) patients had early neurological deterioration. Among 78 patients with early neurological deterioration, 61 (78.2%) had poor functional outcomes at 90 days after stroke onset. By contrast, 131 of 661 (19.8%) patients without early neurological deterioration had poor functional outcomes. Multivariate analysis identified hemorrhagic transformation (OR, 3.8; 95% CI, 1.4-10.5; P=0.010), higher score of NIHSS on admission (OR, 1.4; 95% CI, 1.1-1.7; P=0.003), relevant arterial stenosis (OR, 2.0; 95% CI, 1.2-3.5; p=0.014) and occlusion (OR, 2.6; 95% CI, 1.4-4.8; p=0.004) were the factors associated with early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score on admission, relevant arterial steno-occlusive lesions are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.

The Etiologies of Early Neurological Deterioration after Thrombolysis and Risk Factors of Ischemia Progression

2016 ◽  
Vol 25 (2) ◽  
pp. 383-388 ◽  
Author(s):  
Jeong-Min Kim ◽  
Jangsup Moon ◽  
Suk-Won Ahn ◽  
Hae-Won Shin ◽  
Keun-Hwa Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neurological Deterioration ◽  
Early Neurological Deterioration

scholarly journals A metabolomic study on high-risk stroke patients determines low levels of serum lysine metabolites: a retrospective cohort study

2017 ◽  
Vol 13 (6) ◽  
pp. 1109-1120 ◽  
Author(s):  
Yeseung Lee ◽  
Adnan Khan ◽  
Seri Hong ◽  
Sun Ha Jee ◽  
Youngja H. Park
Keyword(s):  
Cohort Study ◽  
Cerebral Ischemia ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Early Neurological Deterioration ◽  
Low Levels ◽  
Metabolomic Study

Metabolic alteration at early neurological deterioration during cerebral ischemia.

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.

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