Predisposing factors for acute deterioration of minor ischemic stroke

Abstract

Purpose Since attention should be paid to acute stroke patients who may easily worsen, we investigated the predisposing factors for acute deterioration of minor ischemic stroke in Japanese patients. Methods We retrospectively investigated 543 patients who were admitted within 7 days of the occurrence of an acute minor stroke with National Institute of Health Stroke Scale (NIHSS) score of 4 or less, between January 2002 and September 2005. Deterioration of neurological findings was defined as the worsening by 2 points or more of the NIHSS score during admission to the hospital. Results Out of 543 patients, deterioration was noted in 37 patients (6.8%: deterioration group), and not in the other 506 patients (93.2%: non-deterioration group). Multivariate analysis demonstrated that the factors associated with worsening were atherothrombotic brain infarction (deterioration group vs. non-deterioration group: 35.1% vs. 18.0%, P = 0.049), elevated systolic blood pressure (170.5 ± 32.4 mmHg vs. 160.4 ± 27.4 mmHg, P = 0.033), serum glucose level on admission (146.1 ± 60.5 mg/dL vs. 121.7 ± 54.9 mg/dL, P = 0.048), and presence of paralysis (73.0% vs. 54.9%, P = 0.003) and vertigo (16.2% vs. 7.9%, P = 0.034). The more factors there were that were associated with worsening (atherothrombotic infarction; systolic blood pressure > 140 mmHg; serum glucose level > 140 mg/dL; and paralysis, vertigo, and dizziness), the more frequently the deterioration occurred (number of worsening factors 0–2: 4.6%, 3: 12.8%, 4: 32.3%). Although over 80% of patients in the group without deterioration had good functional outcome at discharge, over 90% of patients with deterioration either were discharged to nursing home care or died. Conclusion In this study, the predisposing factors for acute deterioration in minor ischemic stroke were atherothrombotic brain infarction; high blood pressure; elevated serum glucose level; and paralysis, vertigo, and dizziness. Once patients with minor ischemic stroke deteriorated, their functional outcome at discharge was significantly worse than those who had not deteriorated.