Rapidly improving stroke symptoms: a pilot, prospective study.

Area of Science:

• Neurology
• Emergency Medicine
• Clinical Trials

Background:

• Rapidly improving stroke symptoms (RISS) are a debated exclusion criterion for intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke (AIS).
• Understanding RISS frequency and its impact on patient outcomes is crucial for treatment decisions.

Purpose of the Study:

• To estimate the frequency of RISS using four distinct definitions in AIS patients.
• To investigate the association between RISS and clinical outcomes at 90 days post-stroke.

Main Methods:

• A pilot, prospective study enrolled AIS patients within 4.5 hours of symptom onset.
• Serial National Institute of Health Stroke Scale (NIHSS) assessments were conducted before rt-PA treatment decisions.
• RISS was defined by a 4-point improvement, 25% improvement, 50% improvement, or the TREAT criteria; outcomes were assessed using the modified Rankin Scale.

Main Results:

• Fifty AIS patients were included, with a median NIHSS score of 5.
• RISS frequencies ranged from 10% to 22% depending on the definition used.
• Only the TREAT criteria-defined RISS (10% of patients) was associated with a good outcome (modified Rankin Scale ≤1) without rt-PA treatment.

Conclusions:

• Serial NIHSS assessments are feasible and can help quantify RISS frequency and magnitude.
• This study provides the first prospective estimates of RISS frequency and outcomes across multiple definitions.
• The more restrictive TREAT RISS definition shows promise for predicting good outcomes in future research.