Neurofluctuation in patients with subcortical ischemic stroke

Area of Science:

• Neurology
• Stroke Medicine
• Clinical Neuroscience

Background:

• Subcortical stroke (SCS) is a significant cause of neurological deficits.
• Understanding the incidence and impact of neurological deterioration in SCS is crucial for patient management.

Purpose of the Study:

• To assess the incidence of neurological deterioration and fluctuation in patients with subcortical stroke.
• To evaluate the risk of poor outcome associated with deterioration in SCS patients.

Main Methods:

• Prospective observational study of 90 patients admitted with subcortical stroke.
• Daily NIH Stroke Scale evaluations and assessment of neurological deterioration (motor score increase ≥1).
• Modified Rankin Scale scores used to determine outcome at discharge.

Main Results:

• 41% of patients (37/90) experienced neurological deterioration, predominantly within 24 hours of enrollment.
• Deterioration significantly increased the risk of poor outcome (mRS 3-6) (RR 1.80).
• Spontaneous reversion to pre-deterioration deficits occurred in 38% and reduced poor outcome risk (RR 0.12). Tissue plasminogen activator was associated with initial deterioration (HR 2.25) but improved recovery chances post-deterioration (HR 4.36).

Conclusions:

• Neurological deterioration is common in subcortical stroke, occurring early and increasing the risk of adverse outcomes.
• While spontaneous recovery occurs, targeted therapies are needed to prevent, halt, or reverse deterioration in SCS.
• Tissue plasminogen activator may improve recovery after initial deterioration, warranting further investigation.