[Predictors of good prognosis in total anterior circulation infarction]

We analysed the predictive factors for relatively good prognosis in the patients with total anterior circulation infarction (TACI) defined by the Oxfordshire Community Stroke Project. One hundred patients with first-ever ischemic stroke within 6 hours of onset were enrolled. Outcomes were assessed at 3 months using the modified Rankin Scale (mRS), and rated as good if the mRS was 0 to 3, and as bad if the mRS was 4 or 5, or the patient was dead. These two groups were compared in terms of their clinical background, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization and repeated CT at 24 to 48 hours after onset. There were 36 patients with good prognosis and 64 patients with bad prognosis. In univariate analysis, the patients with good prognosis were younger, had lower scores in the National Institutes of Health Stroke Scale (NIHSS, both total score and the score of consciousness sub-item), had fewer rates of deterioration within 7 days than the patients with bad prognosis. In the first cranial CT within 6 hours, the patients with good prognosis had fewer early CT signs including hyperdense middle cerebral artery sign, and brain swelling, as well as infrequent hypodensity more than 33% of total MCA territory, than the patients with bad prognosis. In the second CT during 24 to 48 hours, the patients with good prognosis had smaller lesions than the patients with bad prognosis. In multivariate analysis with logistic regression revealed that age < 70 years, low NIHSS score < or = 15, no deterioration in the acute phase, and small lesion on the second CT were independent predictors of good prognosis.