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2013 ; 22
(8
): e549-56
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A proposal for the classification of etiologies of neurologic deterioration after
acute ischemic stroke
#MMPMID23867039
Siegler JE
; Boehme AK
; Albright KC
; George AJ
; Monlezun DJ
; Beasley TM
; Martin-Schild S
J Stroke Cerebrovasc Dis
2013[Nov]; 22
(8
): e549-56
PMID23867039
show ga
BACKGROUND: Neurologic deterioration (ND) occurs in one third of patients with
ischemic stroke and contributes to morbidity and mortality in these patients.
Etiologies of ND and clinical outcome according to ND etiology are incompletely
understood. METHODS: We conducted a retrospective investigation of all patients
with ischemic stroke admitted to our center (July 2008 to December 2010), who
were known to be last seen normal less than 48 hours before arrival. First-time
episodes of ND during hospitalization were collected in which a patient
experienced a 2-point increase or more in National Institutes of Health Stroke
Scale score within a 24-hour period. Proposed etiologies of reversible ND include
infectious, metabolic, hemodynamic, focal cerebral edema, fluctuation, sedation,
and seizure, whereas new stroke, progressive stroke, intracerebral hemorrhage,
and cardiopulmonary arrest were nonreversible. RESULTS: Of 366 included patients
(median age 65 years, 41.4% women, 68.3% black), 128 (34.9%) experienced ND
(median age 69 years, 42.2% women, 68.7% black). Probable etiologies of ND were
identified in 90.6% of all first-time ND events. The most common etiology of ND,
progressive stroke, was highly associated with poor outcome but not death.
Etiologies most associated with mortality included edema (47.8%), new stroke
(50%), and intracerebral hemorrhage (42.1%). CONCLUSIONS: In the present study,
the authors identified probable etiologies of ND after ischemic stroke.
Delineating the cause of ND could play an important role in the management of the
patient and help set expectations for prognosis after ND has occurred.
Prospective studies are needed to validate these proposed definitions of ND.