Spontaneous Neurological Deterioration in Acute Cardioembolic Stroke: A Subgroup of Patients With Early Severe Prognosis

Abstract

Background: To determine clinical factors of spontaneous early neurological deterioration (END) and prognosis in a cohort of 480 consecutive patients with cardioembolic stroke (CS) without thrombolytic therapy hospitalized within 24 hours of the onset of symptoms. 

Methods: END was defined as a drop of ≥ 1 point in the Canadian Stroke Scale or ≥ 2 points in the Glasgow Coma Scale between admission and after 72 hours. All patients underwent computerized tomography and/or MRI examination. 

Results: END is present in 8.3% of CS patients. CS patients with END (n = 40) in comparison with patients without ND (n = 440) showed a worse early prognosis with statistically significant differences in absence of neurological deficit at hospital discharge (5% versus 17.3%), length of hospitalization (30.8 versus 18.5 days) and in-hospital mortality (47.5% versus 8.4%). In the multivariate analysis, early seizures, severe headache and hypertension were independent clinical predictors of END. 

Conclusions: In patients with CS, early seizures, severe headache and hypertension are clinical variables associated with END. CS with END constitutes a subgroup of patients with severe prognosis. Because most causes of worsening can be treated effectively, the deteriorating cardioembolic stroke patient merits a swift and incisive diagnostic and therapeutic approach.




doi:10.4021/jnr62w