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Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome
BACKGROUND AND PURPOSE: Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefi...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182193/ https://www.ncbi.nlm.nih.gov/pubmed/32330144 http://dx.doi.org/10.1371/journal.pone.0231448 |
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author | Akhtar, Naveed Kamran, Saadat Elkhider, Hisham Al-Makki, Soha Mhjob, Noha ElShiekh, Lubna AlHussain, Hassan Ali, Musab Khodair, Rola Wadiwala, Faisal Salam, Abdul Deleu, Dirk Francis, Reny Shuaib, Ashfaq |
author_facet | Akhtar, Naveed Kamran, Saadat Elkhider, Hisham Al-Makki, Soha Mhjob, Noha ElShiekh, Lubna AlHussain, Hassan Ali, Musab Khodair, Rola Wadiwala, Faisal Salam, Abdul Deleu, Dirk Francis, Reny Shuaib, Ashfaq |
author_sort | Akhtar, Naveed |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefit from thrombolysis. MATERIAL AND METHODS: We interrogated Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Evaluation was based on localization (lacunar or cortical), multi-model imaging abnormalities and whether they received rt-PA. The 90-day mRS was used to determine outcome. RESULTS: During study period 6381 patients were admitted with acute stroke. Mild stroke within 4 hours was diagnosed in 506 [no thrombolysis: 381(lacunar: 213; cortical: 168), thrombolysis: 125 (lacunar: 45; cortical: 80)]. The rt-PA treated patients had significantly higher NIHSS (2.94±3.9 versus 1.28±2.46, p<0.0001), increased rates of complications (16.0% versus 3.9%, p<0.0001) and longer hospital stay (6.05±8.1 versus 3.78±3.6 days; p<0.001). In patients with cortical stroke, intracranial arterial occlusions (11.6% vs 3.9%, p<0.0001) and CTP mismatch (22.2% vs 4.4%, p<0.0001) were more frequent in rt-PA treated patients. Discharge mRS (33.6% versus 13.9%, p<0.001) and 90-days mRS (23.2% versus 11.8%, p = 0.002) was significantly worse in patients with cortical stroke (rt-PA-treated and untreated patients). CONCLUSIONS: The outcome in patients with mild stroke depends on lesion location (lacunar versus cortical) and severity of symptoms. Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of hospital complication, explaining the poor outcome in such subjects. |
format | Online Article Text |
id | pubmed-7182193 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-71821932020-05-05 Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome Akhtar, Naveed Kamran, Saadat Elkhider, Hisham Al-Makki, Soha Mhjob, Noha ElShiekh, Lubna AlHussain, Hassan Ali, Musab Khodair, Rola Wadiwala, Faisal Salam, Abdul Deleu, Dirk Francis, Reny Shuaib, Ashfaq PLoS One Research Article BACKGROUND AND PURPOSE: Patients with acute stroke and mild or rapidly improving symptoms frequently show progression. The role of reperfusion treatment in such patients is not clear. We hypothesized that progression was most likely in patients with cortical localization and such patients may benefit from thrombolysis. MATERIAL AND METHODS: We interrogated Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Evaluation was based on localization (lacunar or cortical), multi-model imaging abnormalities and whether they received rt-PA. The 90-day mRS was used to determine outcome. RESULTS: During study period 6381 patients were admitted with acute stroke. Mild stroke within 4 hours was diagnosed in 506 [no thrombolysis: 381(lacunar: 213; cortical: 168), thrombolysis: 125 (lacunar: 45; cortical: 80)]. The rt-PA treated patients had significantly higher NIHSS (2.94±3.9 versus 1.28±2.46, p<0.0001), increased rates of complications (16.0% versus 3.9%, p<0.0001) and longer hospital stay (6.05±8.1 versus 3.78±3.6 days; p<0.001). In patients with cortical stroke, intracranial arterial occlusions (11.6% vs 3.9%, p<0.0001) and CTP mismatch (22.2% vs 4.4%, p<0.0001) were more frequent in rt-PA treated patients. Discharge mRS (33.6% versus 13.9%, p<0.001) and 90-days mRS (23.2% versus 11.8%, p = 0.002) was significantly worse in patients with cortical stroke (rt-PA-treated and untreated patients). CONCLUSIONS: The outcome in patients with mild stroke depends on lesion location (lacunar versus cortical) and severity of symptoms. Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of hospital complication, explaining the poor outcome in such subjects. Public Library of Science 2020-04-24 /pmc/articles/PMC7182193/ /pubmed/32330144 http://dx.doi.org/10.1371/journal.pone.0231448 Text en © 2020 Akhtar et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Akhtar, Naveed Kamran, Saadat Elkhider, Hisham Al-Makki, Soha Mhjob, Noha ElShiekh, Lubna AlHussain, Hassan Ali, Musab Khodair, Rola Wadiwala, Faisal Salam, Abdul Deleu, Dirk Francis, Reny Shuaib, Ashfaq Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title | Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title_full | Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title_fullStr | Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title_full_unstemmed | Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title_short | Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome |
title_sort | progression of stroke deficits in patients presenting with mild symptoms: the underlying etiology determines outcome |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182193/ https://www.ncbi.nlm.nih.gov/pubmed/32330144 http://dx.doi.org/10.1371/journal.pone.0231448 |
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