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Updated: Aug 15, 2026
Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
Published on: February 22, 2020
Predictors of major neurologic improvement after thrombolysis in acute stroke
Gustavo Saposnik1, Silvia Di Legge, Fiona Webster
1Department of Clinical Neurological Sciences, London Health Science Center, The University of Western Ontario, London, Ontario, Canada. gsaposni@uwo.ca
Background:
Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months.
Objective:
To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months.
Methods:
The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003. Major neurologic improvement was defined by a > or = 8-point improvement in NIH Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 hours. Good outcome was defined as a 3-month modified Rankin Scale of 0 to 1.
Results:
Of 219 patients with acute stroke treated with rt-PA, 61 (28%) had major neurologic improvement at 24 hours. Glucose levels < 8 mmol/L (OR 4.98, 95% CI 1.6 to 15.2), lack of cortical involvement on 24 hour CT scan (OR 3.97, 95% CI 1.87 to 8.43), and female sex (OR 2.4, 95% CI 1.12 to 5.13) were associated with major neurologic improvement after adjusting for covariates. Patients with major neurologic improvement had a shorter hospital stay (6.7 vs 14.3 days; p = 0.001). Major neurologic improvement was an independent predictor of good outcome at 3 months (OR 12.8, 95% CI 4.72 to 34.6).
Conclusions:
Major neurologic improvement after rt-PA was observed in 28% of patients and independently predicted good outcome at 3 months. Female sex, glucose levels < 8 mmol/L, and absence of cortical involvement at 24 hours CT scan were associated with major neurologic improvement.
