EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE: POTENTIAL PREDICTORS, CAUSES AND RELATION TO INFARCT GROWTH | ||||
| Ain Shams Medical Journal | ||||
| Article 17, Volume 70, 10, 11 & 12, July 2019, Page 747-758 PDF (205.14 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asmj.2019.101287 | ||||
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| Authors | ||||
| Samia Ashour Mohamed Helal; Hany Amin Aref; Ayman Mohammed Nassef; Ramez Reda Moustafa; Mohammed Amir Tork; Ehab Abd Elbaset Abdulsamad | ||||
| Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. | ||||
| Abstract | ||||
| Background: Worsening of acute stroke early in its course (within 48–72 h of its onset) is a common occurrence and has potentially serious short term and long term consequences. The incidence of early neurological deterioration (END) among hospitalized patients varies widely in different studies between 13% and 38%. Aim of the Work: To define incidence and timing of END in relation to acute ischemic stroke (AIS) onset. To identify possible causes and predictors associated with END. To assess the relation between END and the patient functional level at three months post stroke. Patients and Methods: Three hundred patients were recruited into this hospital prospective comparative study. Clinical history, laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultrasonography were done. Patients were examined on NIHSS and Glasgow Coma Scale (GCS) in day 1, 2, 3 and patients with END did a follow up (MRI diffusion film or CT brain) at day4 or 5 and all patients were followed up by Modified Rankin scale (MRs) at three-month post stroke. Results: Of the Three hundred patients included in the study, the incidence of END was 16.7%. The median NIHSS on admission was 9.25. END was associated with long duration of DM (P 0.012), IHD (p 0.015), AF (p 0.048), severe stroke (p 0.0044), low blood pressure on admission (p 0.0079), high uric acid (p 0.033) and MCA occlusion (p 0.0007). END was associated with significant increase in MRS at 3 month (p<0.0001) and mortality rate (44% vs 4.4). Patients with END are more prone for aspiration pneumonia (p 0.0001) and hemorrhagic transformation. Conclusion: Early neurological deterioration is a frequent complication after acute stroke, with a poor short-term prognosis. This study provides that hyperglycemia, hyperuricemia and cardiac disease (IHD and AF) may increase the risk of END. | ||||
| Keywords | ||||
| Early Neurological Deterioration; Acute Ischemic Stroke | ||||
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