Progressing Neurological Deficit Secondary to Acute Ischemic Stroke: A Study on Predictability, Pathogenesis, and Prognosis

Danilo Toni, Marco Fiorelli, Mara Gentile, Stefano Bastianello, Maria Luisa Sacchetti, Corrado Argentino, Carlo Pozzilli, Cesare Fieschi

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

To identify predictors and possible pathogenetic mechanisms of early neurological deterioration in patients with acute ischemic strokes and to evaluate their impact on clinical outcome. Case series. University hospital's stroke unit. A continuous series of 152 patients with firstever ischemic hemispheric strokes were hospitalized within 5 hours of onset, evaluated with the Canadian Neurological Scale, and underwent a computed tomographic (CT) scan. The initial subset of 80 patients also underwent angiography. A repeated CT scan or autopsy was performed within 5 to 9 days of a patient's stroke. Progressing neurological deficit was defined as a decrease of one point or more in the global neurological scale score during hospitalization, when compared with that at entry. The conditions of 39 patients (26%) deteriorated during the initial 4 days; 20 patients (51%) had an impaired level of consciousness, and 19 patients (49%) had impaired limb strength and/or speech. They had been hospitalized earlier and had higher serum glucose levels at admission; the baseline CT scans of these patients showed an early focal hypodensity and initial mass effect more frequently. On the repeated CT scan (144 patients) or at autopsy (eight patients), patients with a progressing course more frequently had large infarcts, severe mass effect, and hemorrhagic infarction. We found no differences with regard to demographic data, medical history, and treatments that were given; only subcutaneous heparin calcium was more frequently administered to patients with a progressing course. Twenty-two (27%) of the 80 patients who underwent angiography had a progressing course, of whom 20 (91%) had an intracranial and/or extracranial arterial occlusion, with collateral blood supply in seven patients (35%). Logistic regression analysis showed that the independent predictors of progression were the serum glucose levels at admission and the early focal hypodensity with cortical and corticosubcortical locations, with the positive predictive values of the latter being 34% (95% confidence interval [CI], 26% to 42%) and 57% (95% CI, 47% to 67%), respectively. Among patients who underwent angiography, logistic regression analysis showed a significant correlation between carotid siphon occlusion and a progressing course. The 30-day case-fatality ratio and disability (Barthel index,

Original languageEnglish
Pages (from-to)670-675
Number of pages6
JournalArchives of Neurology
Volume52
Issue number7
DOIs
Publication statusPublished - 1995

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Stroke
Angiography
Predictability
Autopsy
Logistic Models
Regression Analysis
Confidence Intervals
Glucose
Hospital Units
Serum
Consciousness
Infarction
Hospitalization
Extremities
Demography

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology
  • Neuroscience(all)

Cite this

Progressing Neurological Deficit Secondary to Acute Ischemic Stroke : A Study on Predictability, Pathogenesis, and Prognosis. / Toni, Danilo; Fiorelli, Marco; Gentile, Mara; Bastianello, Stefano; Sacchetti, Maria Luisa; Argentino, Corrado; Pozzilli, Carlo; Fieschi, Cesare.

In: Archives of Neurology, Vol. 52, No. 7, 1995, p. 670-675.

Research output: Contribution to journalArticle

Toni, Danilo ; Fiorelli, Marco ; Gentile, Mara ; Bastianello, Stefano ; Sacchetti, Maria Luisa ; Argentino, Corrado ; Pozzilli, Carlo ; Fieschi, Cesare. / Progressing Neurological Deficit Secondary to Acute Ischemic Stroke : A Study on Predictability, Pathogenesis, and Prognosis. In: Archives of Neurology. 1995 ; Vol. 52, No. 7. pp. 670-675.
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AU - Bastianello, Stefano

AU - Sacchetti, Maria Luisa

AU - Argentino, Corrado

AU - Pozzilli, Carlo

AU - Fieschi, Cesare

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