Acute ischemic strokes improving during the first 48 hours of onset: Predictability, outcome and possible mechanisms: A comparison with early deteriorating strokes

Danilo Toni, Marco Fiorelli, Stefano Bastianello, Anne Falcou, Giuliano Sette, Vanessa Ceschin, Maria Luisa Sacchetti, Corrado Argentino

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: Our aims were to identify predictors of early neurological improvement in acute ischemic stroke patients, to evaluate its impact on clinical outcome, and to investigate possible mechanisms. Methods: A consecutive series of 152 first-ever ischemic hemispheric stroke patients hospitalized within 5 hours of onset underwent a first CT scan within 1 hour of hospitalization, and the initial subset of 80 patients also underwent angiography. During the first 48 hours of hospital stay an increase or a decrease of 1 or more points in the admission Canadian Neurological Scale (CNS) score was defined as early improvement or early deterioration, respectively. Repeated CT scan or autopsy was performed 5 to 9 days after stroke. Results: Thirty-four patients (22%) improved, 84 (56%) remained stable, and 34 (22%) deteriorated. Logistic regression, which took into account vascular risk factors, baseline clinical and (T data, and therapies administered, selected younger age, lower admission CNS score, and absence of early hypodensity at first CT as independent predictors of early improvement. Among the patients who underwent angiography, logistic regression selected arterial patency and presence of collateral blood supply as independent predictors of early improvement. At the repeated CT scan or autopsy, improving patients presented the highest frequency of small infarcts. Thirty-day case-fatality rate and disability were lower in improving patients. Variables independently associated with outcome at logistic regression were admission CNS score, early deterioration, and early improvement. Conclusions: Early improvement can be predicted by the absence of early CT hypodensity and is highly predictive of good outcome. Presence of collateral blood supply and presumably early spontaneous recanalization are likely to be the mechanisms underlying early improvement.

Original languageEnglish
Pages (from-to)10-14
Number of pages5
JournalStroke
Volume28
Issue number1
Publication statusPublished - Jan 1997

Keywords

  • cerebral ischemia
  • outcome
  • prognosis
  • stroke, acute

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

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