Defining minor symptoms in acute ischemic stroke

Davide Strambo, Alberto A. Zambon, Luisa Roveri, Giacomo Giacalone, Giovanni Di Maggio, Luca Peruzzotti-Jametti, Sara La Gioia, Sebastiano Galantucci, Giancarlo Comi, Maria Sessa

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40% of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. Methods: Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. Results: Three months after stroke onset, 97 patients (31.9%) had mRS ≥2. Independent predictors of poor outcome were age (OR 0.97 [95% CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95% CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95% CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95% CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95% CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. Conclusions: Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.

Original languageEnglish
Pages (from-to)209-215
Number of pages7
JournalCerebrovascular Diseases
Volume39
Issue number3-4
DOIs
Publication statusPublished - May 6 2015

Fingerprint

Stroke
Comorbidity

Keywords

  • Acute stroke outcome
  • Minor stroke
  • Minor symptoms
  • Prognosis
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Strambo, D., Zambon, A. A., Roveri, L., Giacalone, G., Di Maggio, G., Peruzzotti-Jametti, L., ... Sessa, M. (2015). Defining minor symptoms in acute ischemic stroke. Cerebrovascular Diseases, 39(3-4), 209-215. https://doi.org/10.1159/000375151

Defining minor symptoms in acute ischemic stroke. / Strambo, Davide; Zambon, Alberto A.; Roveri, Luisa; Giacalone, Giacomo; Di Maggio, Giovanni; Peruzzotti-Jametti, Luca; La Gioia, Sara; Galantucci, Sebastiano; Comi, Giancarlo; Sessa, Maria.

In: Cerebrovascular Diseases, Vol. 39, No. 3-4, 06.05.2015, p. 209-215.

Research output: Contribution to journalArticle

Strambo, D, Zambon, AA, Roveri, L, Giacalone, G, Di Maggio, G, Peruzzotti-Jametti, L, La Gioia, S, Galantucci, S, Comi, G & Sessa, M 2015, 'Defining minor symptoms in acute ischemic stroke', Cerebrovascular Diseases, vol. 39, no. 3-4, pp. 209-215. https://doi.org/10.1159/000375151
Strambo D, Zambon AA, Roveri L, Giacalone G, Di Maggio G, Peruzzotti-Jametti L et al. Defining minor symptoms in acute ischemic stroke. Cerebrovascular Diseases. 2015 May 6;39(3-4):209-215. https://doi.org/10.1159/000375151
Strambo, Davide ; Zambon, Alberto A. ; Roveri, Luisa ; Giacalone, Giacomo ; Di Maggio, Giovanni ; Peruzzotti-Jametti, Luca ; La Gioia, Sara ; Galantucci, Sebastiano ; Comi, Giancarlo ; Sessa, Maria. / Defining minor symptoms in acute ischemic stroke. In: Cerebrovascular Diseases. 2015 ; Vol. 39, No. 3-4. pp. 209-215.
@article{6d4dc92823b248139804b2ed01f2b840,
title = "Defining minor symptoms in acute ischemic stroke",
abstract = "Background: Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40{\%} of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. Methods: Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. Results: Three months after stroke onset, 97 patients (31.9{\%}) had mRS ≥2. Independent predictors of poor outcome were age (OR 0.97 [95{\%} CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95{\%} CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95{\%} CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95{\%} CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95{\%} CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. Conclusions: Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.",
keywords = "Acute stroke outcome, Minor stroke, Minor symptoms, Prognosis, Stroke",
author = "Davide Strambo and Zambon, {Alberto A.} and Luisa Roveri and Giacomo Giacalone and {Di Maggio}, Giovanni and Luca Peruzzotti-Jametti and {La Gioia}, Sara and Sebastiano Galantucci and Giancarlo Comi and Maria Sessa",
year = "2015",
month = "5",
day = "6",
doi = "10.1159/000375151",
language = "English",
volume = "39",
pages = "209--215",
journal = "Cerebrovascular Diseases",
issn = "1015-9770",
publisher = "S. Karger AG",
number = "3-4",

}

TY - JOUR

T1 - Defining minor symptoms in acute ischemic stroke

AU - Strambo, Davide

AU - Zambon, Alberto A.

AU - Roveri, Luisa

AU - Giacalone, Giacomo

AU - Di Maggio, Giovanni

AU - Peruzzotti-Jametti, Luca

AU - La Gioia, Sara

AU - Galantucci, Sebastiano

AU - Comi, Giancarlo

AU - Sessa, Maria

PY - 2015/5/6

Y1 - 2015/5/6

N2 - Background: Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40% of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. Methods: Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. Results: Three months after stroke onset, 97 patients (31.9%) had mRS ≥2. Independent predictors of poor outcome were age (OR 0.97 [95% CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95% CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95% CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95% CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95% CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. Conclusions: Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.

AB - Background: Thrombolysis is often withheld from acute ischemic stroke patients presenting with mild symptoms; however, up to 40% of these patients end up with a poor outcome when left untreated. Since there is lack of consensus on the definition of minor symptoms, we aimed at addressing this issue by looking for features that would better predict functional outcomes at 3 months. Methods: Among all acute ischemic stroke patients admitted to our Stroke Unit (n = 1,229), we selected a cohort of patients who arrived within 24 hours from symptoms onset, with baseline NIHSS ≤6, not treated with thrombolysis (n = 304). Epidemiological data, comorbidities, radiological features and clinical presentation (NIHSS items) were collected to identify predictors of outcome. Our cohort was tested against minor stroke definitions selected from the literature and a newly proposed one. Results: Three months after stroke onset, 97 patients (31.9%) had mRS ≥2. Independent predictors of poor outcome were age (OR 0.97 [95% CI 0.95-9.99]) and baseline NIHSS score (OR 0.79 [95% CI 0.67-0.94]), while cardioembolic aetiology was negatively associated (OR 3.29 [95% CI 1.51-7.14]). Items of NIHSS associated with poor outcome were impairment of right motor arm (OR 0.49 [95% CI 0.27-0.91]) or the involvement of any of the motor items (OR 0.69 [95% CI 0.48-0.99]). The definition of minor stroke as NIHSS ≤3 and the new proposed definition had the highest sensitivity and accuracy and were independent predictors of outcome. Conclusions: Our study confirmed that in spite of a low NIHSS score, one third of patients had poor outcome. As already described, age and NIHSS score remained independent predictors of poor outcome even in mild stroke. Also, motor impairment appeared a major determinant of poor outcome. The new proposed definition of minor stroke featured the NIHSS score and the NIHSS items that better predicted functional outcome. Awareness that even minor stroke can yield to poor outcome should sensitize patients to arrive early to the ED and neurologists to administer rt-PA.

KW - Acute stroke outcome

KW - Minor stroke

KW - Minor symptoms

KW - Prognosis

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84925438745&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925438745&partnerID=8YFLogxK

U2 - 10.1159/000375151

DO - 10.1159/000375151

M3 - Article

VL - 39

SP - 209

EP - 215

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

SN - 1015-9770

IS - 3-4

ER -