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. 2017 Winter:4:18-24.
doi: 10.15404/msrj/03.2016.0005.

Time to Neurological Deterioration in Ischemic Stroke

James E Siegler  1 , Karen C Albright  2   3   4   5 , Alexander J George  1 , Amelia K Boehme  2 , Michael A Gillette  1 , Andre D Kumar  1 , Monica Aswani  6 , Sheryl Martin-Schild  1
Affiliations

Time to Neurological Deterioration in Ischemic Stroke

James E Siegler et al. Med Student Res J. 2017 Winter.

Abstract

Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke. The timing of ND with respect to ND etiology and reversibility has not been investigated.

Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility. ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion.

Results: Seventy-one of 350 ischemic stroke patients experienced ND. Over half (54.9%) of the patients who experienced ND did so within the 48 hours of last seen normal. The median time to ND for non-reversible causes was 1.5 days (IQR 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p=0.011). After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient's age, we expect a 3.9% shorter time to ND (p=0.0257). In addition, adjusting for age and hematocrit on admission, we found that that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p=0.0034).

Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.

Keywords: Acute ischemic stroke; latency; neurological deterioration; time to event analysis.

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Figures

Figure 1
Figure 1. Log normal (parametric) survival curve demonstrating time to neurological deterioration with Cox proportional hazards curve overlaid
Figure demonstrates the time to neurological deterioration using two separate models.
Figure 2
Figure 2. Kaplan Meier survival curve comparing time to neurological deterioration for patients with non-reversible causes of ND to patients with reversible causes of ND with log normal curves overlaid
Figure depicts Kaplan Meier and log normal curves evaluating differences in time to neurological deterioration according to reversible and non-reversible etiologies. Log Rank p=0.007 for differences.
See this image and copyright information in PMC

References

    1. Davalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke; a journal of cerebral circulation. 1999;30(12):2631–6. - PubMed
    1. Siegler JE, Martin-Schild S. Early Neurological Deterioration (END) after stroke: the END depends on the definition. International journal of stroke: official journal of the International Stroke Society. 2011;6(3):211–2. - PubMed
    1. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the National Institutes of Health Stroke Scale should define neurologic deterioration in acute ischemic stroke? Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. 2013;22(5):675–82. - PMC - PubMed
    1. Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM: monthly journal of the Association of Physicians. 2006;99(9):625–33. - PubMed
    1. DeGraba TJ, Hallenbeck JM, Pettigrew KD, Dutka AJ, Kelly BJ. Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials. Stroke; a journal of cerebral circulation. 1999;30(6):1208–12. - PubMed

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