Poststroke neurological improvement within 7 days is associated with subsequent deterioration

Area of Science:

• Neurology
• Clinical Neuroscience
• Stroke Medicine

Background:

• Early improvement in the National Institutes of Health Stroke Scale (NIHSS) after stroke is linked to later neurological deterioration.
• This phenomenon, observed within 24 hours, prompted investigation into its occurrence later in the stroke recovery phase.

Purpose of the Study:

• To investigate if substantial neurological recovery at 7 days post-stroke predicts subsequent neurological deterioration between day 7 and day 90.
• To evaluate the association between early recovery and later adverse neurological events in ischemic stroke patients.

Main Methods:

• Analysis of data from the Glycine Antagonist (gavestinel) In Neuroprotection (GAIN) International Trial, focusing on ischemic stroke patients alive at day 7.
• Neurological deterioration was assessed using a composite measure including serious adverse events, recurrent stroke, and worsening of NIHSS scores.
• Logistic regression was employed to determine the association between NIHSS recovery at 7 days and subsequent deterioration, adjusting for covariates.

Main Results:

• Among 1187 patients, 25% achieved over 65% recovery by day 7.
• A higher prevalence of neurological deterioration was observed in patients with >65% recovery at day 7 (15.5%) compared to those with less recovery (10.3%; P=0.01).
• Each 10% increase in recovery at day 7 was associated with a 20% increased odds of subsequent neurological deterioration (OR, 1.2; 95% CI, 1.1 to 1.3).

Conclusions:

• Substantial neurological recovery at 7 days after ischemic stroke is associated with an increased risk of subsequent neurological deterioration up to 90 days.
• These findings suggest that patients demonstrating significant early recovery require continued close monitoring for potential delayed decline.