Early recovery after cerebral ischemia risk of subsequent neurological deterioration

• Published in: Annals of neurology 2003-10, Vol.54 (4), p.439-444
• Main Authors: Johnston, S. Claiborne, Leira, Enrique C., Hansen, Michael D., Adams Jr, Harold P.
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants; Biological and medical sciences; Blood Glucose; Blood Pressure; Case-Control Studies; Chondroitin Sulfates - therapeutic use; Dermatan Sulfate - therapeutic use; Disease Progression; Drug Combinations; Female; Follow-Up Studies; Heart Rate; Heparitin Sulfate - therapeutic use; Humans; Ischemic Attack, Transient - classification; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - drug therapy; Male; Medical sciences; Middle Aged; Nervous System Diseases - diet therapy; Nervous System Diseases - etiology; Neurologic Examination; Neurology; Odds Ratio; Randomized Controlled Trials as Topic; Recovery of Function; Risk; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.10678

Given the high short‐term risk of stroke after transient ischemic attack, we hypothesized that substantial acute neurological recovery in patients presenting with cerebral ischemia would be associated with a greater risk of subsequent neurological deterioration due to recurrent cerebral ischemia. Data from the Trial of ORG10172 in Acute Stroke Treatment, a randomized trial of the heparinoid danaparoid, were analyzed to determine whether substantial acute recovery, defined as an improvement of greater than or equal to 75% on National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 hours, was associated with a greater risk of subsequent deterioration, defined as a worsening on the NIHSS between day 1 and day 90. Of 1,184 subjects meeting entry criteria, 63 (5.3%) had substantial acute recovery. Subsequent deterioration was more common in those with substantial acute recovery compared with others (48 vs 33%; p = 0.028 by Fisher's exact test). In multivariable models, substantial acute recovery remained an independent predictor of subsequent deterioration (odds ratio, 3.0; 95% confidence interval, 1.7–5.2; p < 0.001). Among patients with acute cerebral ischemia, those who recover substantially within 24 hours may be at greater risk of subsequent neurological deterioration due to causes other than hemorrhage.