Defining minor symptoms in acute ischemic stroke.

Area of Science:

• Neurology
• Stroke Medicine
• Clinical Outcomes Research

Background:

• Thrombolysis is often withheld for acute ischemic stroke with mild symptoms.
• However, up to 40% of untreated mild stroke patients experience poor functional outcomes.
• A clear definition of minor stroke is lacking, necessitating improved prediction of functional outcomes.

Purpose of the Study:

• To identify features that better predict functional outcomes at 3 months in acute ischemic stroke patients with mild symptoms.
• To address the lack of consensus on the definition of minor stroke.
• To evaluate existing and propose a new definition for minor stroke prediction.

Main Methods:

• A cohort of 304 acute ischemic stroke patients with baseline NIHSS ≤6, treated within 24 hours, and not receiving thrombolysis was analyzed.
• Epidemiological data, comorbidities, radiological features, and NIHSS items were collected.
• The cohort was evaluated against literature-based and a newly proposed minor stroke definitions.

Main Results:

• 97 patients (31.9%) experienced poor outcomes (mRS ≥ 2) at 3 months.
• Independent predictors of poor outcome included older age and higher baseline NIHSS score.
• Motor impairment (right arm or any motor item) and cardioembolic etiology were significant predictors.

Conclusions:

• One-third of mild stroke patients experience poor outcomes, underscoring the need for early intervention.
• Age, NIHSS score, and motor deficits are crucial predictors of functional outcome in mild stroke.
• A new definition incorporating NIHSS score and specific items offers improved prediction accuracy for minor stroke.