Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and...

Area of Science:

• Neurology
• Radiology
• Clinical Medicine

Background:

• Early neurological deterioration significantly impacts patient outcomes after acute ischemic stroke.
• Predicting and understanding the mechanisms of this deterioration is crucial for effective treatment strategies.

Purpose of the Study:

• To identify predictors of early neurological deterioration in acute ischemic stroke patients.
• To explore potential pathogenetic mechanisms underlying this deterioration.
• To evaluate the impact of early deterioration on clinical outcomes.

Main Methods:

• A case series of 152 patients with first-ever ischemic hemispheric strokes admitted within 5 hours of onset.
• Evaluation included the Canadian Neurological Scale and computed tomographic (CT) scans; a subset underwent angiography.
• Neurological deficit progression was defined as a decrease of one point or more on the global neurological scale.

Main Results:

• 26% of patients experienced deterioration within 4 days, often associated with impaired consciousness or limb strength/speech.
• Predictors included earlier hospitalization, higher serum glucose, and early focal hypodensity on baseline CT scans.
• Angiography revealed arterial occlusion in 91% of deteriorating patients; carotid siphon occlusion correlated with progression.
• Deteriorating patients had higher 30-day case-fatality (36%) and disability (54%) rates.

Conclusions:

• Early stroke deterioration is difficult to predict but is associated with cerebral edema secondary to arterial occlusion, evidenced by early CT findings.
• Early focal hypodensity and initial mass effect on CT scans are key indicators.
• Early deterioration strongly predicts a poor outcome, suggesting its potential as an early surrogate endpoint in therapeutic trials.