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Spontaneous improvement after acute ischemic stroke. A pilot study.

J Biller1, B B Love, E E Marsh

  • 1Department of Neurology, University of Iowa College of Medicine, Iowa City 52242.

Stroke
|July 1, 1990
PubMed
Summary
This summary is machine-generated.

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Many acute ischemic stroke patients show spontaneous improvement within 6 hours, even without treatment. This natural recovery needs consideration when evaluating new stroke therapies.

Area of Science:

  • Neurology
  • Clinical Medicine
  • Stroke Research

Background:

  • Early treatment (within 12 hours) is crucial for acute ischemic stroke.
  • Proposed therapies often rely on observed early clinical improvement.
  • The rate of spontaneous recovery in acute ischemic stroke patients is not well understood.

Purpose of the Study:

  • To prospectively evaluate the natural course of acute ischemic stroke.
  • To determine the frequency and degree of spontaneous improvement in patients treated within 12 hours of stroke onset.
  • To inform the design of clinical trials for acute stroke treatments.

Main Methods:

  • Prospective evaluation of 29 acute ischemic stroke patients (onset to <= 12 hours).
  • Patients assessed within 6 hours (n=17) or 6-12 hours (n=12) of onset.

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  • Modified National Institutes of Health Stroke Scale (NIHSS) used at baseline and 1, 2, 3, 6 hours.
  • No acute stroke-specific treatments administered during the observation period.

    • Main Results:

    • 24% of patients showed improvement (>= 2-point NIHSS decrease) by 1 hour.
    • By 6 hours, 52% of patients had improved spontaneously.
    • At 6 hours, 41% remained unchanged, and 7% worsened.

    Conclusions:

    • Spontaneous, significant neurological improvement occurs frequently in acute ischemic stroke patients.
    • The natural course of recovery must be accounted for in clinical trial designs.
    • Observed early improvements in trials may not solely be due to therapeutic interventions.