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Temporal profile (clinical course) of acute carotid system cerebral infarction
Insights
This study tracked 179 acute carotid system cerebral infarction patients. Most patients showed stable or improving neurological status within seven days, but some experienced worsening, highlighting the need for timely intervention.
Area of Science:
- Neurology
- Cerebrovascular Medicine
- Clinical Neuroscience
Background:
- Acute carotid system cerebral infarction presents a significant clinical challenge.
- Understanding the early clinical course is crucial for patient management.
- Temporal profiles of neurological deficits inform prognosis and treatment strategies.
Purpose of the Study:
- To delineate the temporal profile of clinical events in the first week following acute carotid system cerebral infarction.
- To identify patient subgroups with distinct neurological trajectories.
- To assess early mortality rates and associated risk factors.
Main Methods:
- Retrospective analysis of 179 consecutive patients with acute carotid system cerebral infarction.
- Inclusion criteria: admission within 36 hours of symptom onset.
- Neurological status and clinical course were monitored during the first seven days.
Main Results:
- 39% of patients maintained stable neurological status at seven days; 35% showed gradual improvement.
- 19% experienced initial progression stabilizing within 48 hours.
- A subgroup (4%) exhibited late worsening after 48 hours; overall mortality was 11%.
- Decreased consciousness and hemiplegia at admission predicted a high mortality risk (41%).
Conclusions:
- The majority of acute carotid system cerebral infarction patients exhibit stable or improving neurological status within the first week.
- A significant minority experience initial progression or late worsening, necessitating close monitoring.
- Admission neurological deficits, particularly decreased consciousness and hemiplegia, are critical indicators of poor prognosis and increased mortality risk.
Abstract:
The records of 179 consecutive patients with acute carotid system cerebral infarction were studied to describe the temporal profile of the clinical events during the first week of the illness. Only those patients admitted to the cerebrovascular hospital service within 36 hours of the onset of the first symptom were included. The neurological status of 39% was stable (unchanged) at the end of seven days; 35% of the patients gradually improved. Nineteen percent had a progressing neurological deficit from the onset which stabilized within 48 hours of onset. Six patients (3%) had a remitting-relapsing course during the first 36 hours. Eight patients (4%) had a significant late worsening, after 48 hours of stable or improving course. Mortality was 11% for the entire group. However, a high risk of death group was identified - the mortality was 41% for those patients who had any degree of decreased level of consciousness and hemiplegia at the time of admission.