Higher National Institutes Of Health Stroke Scale Score Research Articles

Outcomes of reperfusion therapy for acute ischaemic stroke in patients aged 90 years or older: a retrospective study.

The benefits and risks of acute reperfusion therapy (RT) in acute ischaemic stroke (AIS) remain uncertain in older patients, especially in nonagenarians. We aimed to assess the impact of RT in this population. Single-center retrospective cohort study comparing patients ≥ 90years old admitted to a Stroke Unit (2008-2018) with AIS, submitted or not to RT [intravenous thrombolysis(IVT), mechanical thrombectomy(MT) or both]. Baseline characteristics, in-hospital complications and 3-month outcomes were compared. The primary outcome was 3-month "favorable outcome", defined as modified Rankin Scale score 0-2 or equal to pre-stroke. Secondary outcomes were haemorrhagic transformation (HT) and 3months mortality. We included 167 patients (median age 92years, 66.5% females); 46.1% underwent RT (59 IVT, 11 MT, 7 both). RT group had higher admission National Institutes of Health Stroke Scale (NIHSS) (16 versus 9.5, p < 0.001). Favorable outcome occurred in only 22% of patients, with no differences between groups; its odds decreased with higher NIHSS scores (OR 0.80, 95%CI 0.73-0.87, p < 0.001) and with the development of in-hospital respiratory infection (OR 0.22, 95%CI 0.07-0.67, p = 0.007). HT occurred in 16.2% of patients, being more prevalent (26.0% versus 7.8%, p = 0.001), symptomatic (14.3% versus 3.3%, p = 0.011) and severe (PH1/2 15.6% versus 2.2%, p = 0.012) in the RT group, although it did not influence the primary outcome. Mortality was 32% at 3months, with no difference between groups. Although patients submitted to RT had worse admission NIHSS and increased HT, they had similar functional outcome at 3months. Stroke severity and in-hospital respiratory infections were the most important predictors of 3months' functional outcome.

National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases

The National Institutes of Health Stroke Scale (NIHSS) score is the most frequently used score worldwide for assessing the clinical severity of a stroke. Prior research suggested an association between acute symptomatic seizures after stroke and poorer outcome. We determined the frequency of acute seizures after ischemic stroke in a large population-based registry in a central European region between 2004 and 2016 and identified risk factors for acute seizures in univariate and multivariate analyses. Additionally, we determined the influence of seizures on morbidity and mortality in a matched case–control design. Our analysis of 135,117 cases demonstrated a seizure frequency of 1.3%. Seizure risk was 0.6% with an NIHSS score at admission <3 points and increased up to 7.0% with >31 score points. Seizure risk was significantly higher in the presence of acute non-neurological infections (odds ratio: 3.4; 95% confidence interval: 2.8–4.1). A lower premorbid functional level also significantly increased seizure risk (OR: 1.7; 95%CI: 1.4–2.0). Mortality in patients with acute symptomatic seizures was almost doubled when compared to controls matched for age, gender, and stroke severity. Acute symptomatic seizures increase morbidity and mortality in ischemic stroke. Their odds increase with a higher NIHSS score at admission.

The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients.

BackgroundTo characterize the severity and distribution of white matter hyperintensities (WMHs) and to assess the relationship of WMHs with initial stroke severity, 3-month functional outcome, stroke recurrence and response to antiplatelet therapies.MethodsIn Clopidogrel High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 787 minor stroke patients with baseline magnetic resonance imaging (MRI) information were included in this analysis. Deep and periventricular WMHs (DWMHs and PVWMHs) were rated using the Fazekas scale and categorized into mild (grades 0–2), moderate (grades 3–4) and severe (grades 5–6). Multivariable logistic regression was used to examine the associations between WMHs severities and outcomes, including initial stroke severity by the National Institutes of Health Stroke Scale (NIHSS) scores, 3-month functional outcome by modified Rankin Scale (mRS), and stroke recurrence. Cox proportional hazards model was used to assess the treatment-by-subgroup interaction effect.ResultsAmong the 787 patients in this analysis, 432 (54.9%) had moderate or severe WMHs (3-6). Compared with mild WMHs, the adjusted odds ratio (OR) of severe WMHs for risk of higher NIHSS was 2.10, 95% confidence interval (CI), 1.26–3.48 (P=0.004). Both severities of SDWMHs (OR 1.66; 95% CI, 1.15–2.40; P=0.007) and PVWMHs (OR 1.47; 95% CI, 1.02–2.10; P=0.04) were associated with higher NIHSS scores. There were no statistically significant associations of WMHs with 3-month functional outcome and stroke recurrence. There were no significant interactions between WMHs and antiplatelet therapy.ConclusionsIn patients with minor stroke, both SDWMHs and PVWMHs might related with initial stroke severity. No interaction was detected between the severity of WMHs and antiplatelet treatment.Trial registrationClinicalTrials.gov identifier: NCT00979589. Date of registration: Sep 18, 2009.

Does the Babinski sign predict functional outcome in acute ischemic stroke?

ObjectiveThe aim of this prospective cohort study was to determine the incidence and neuroimaging risk factors associated with Babinski sign following acute ischemic stroke, as well as its relationship with the functional outcome of patients.MethodsA total of 351 patients were enrolled in the study within 7 days of acute ischemic stroke. The Babinski sign along with other upper motor neuron signs were examined upon admission and between days 1 and 3 and days 5 and 7 after admission. Neuroimaging parameters included site and volume of infarction and white matter lesions. All patients were followed up at 3 months. Functional outcome was assessed with the Lawton Activities of Daily Living scale and modified Rankin Scale.ResultsBabinski sign was observed in 115 of 351 (32.8%) patients in the acute ischemic stroke. These patients had higher National Institutes of Health Stroke Scale (NIHSS) scores at admission and higher rates of atrial fibrillation and cardioembolism; higher frequencies of frontal, temporal, and limbic lobes and basal ganglia infarcts; and larger infarct volume. Higher NIHSS score and basal ganglia infarct were significant predictors of the presence of Babinski sign. After adjusting for confounds, the presence of Babinski sign did not predict poor functional outcome.ConclusionThe incidence of Babinski sign was 32.8% in the acute ischemic stroke. Severe infarction and basal ganglia infarct were independent predictors of Babinski sign. Although Babinski sign is common in acute ischemic stroke patients, it does not predict poor functional outcome 3 months later.

Detection of airway protective level of the cough reflex in acute stroke patients

BackgroundThe most common respiratory complications in cerebrovascular strokes were respiratory infection, pulmonary edema, acute lung injury (ALI) acute respiratory distress syndrome (ARDS) and pulmonary embolism (PE). The inhalation cough challenge facilitates the quantification of cough.ObjectivesTo detect the level of cough reflex that is enough to protect against respiratory infection in stroke patients, and to identify predictors of post-stroke respiratory infection.Patients and methodsOne hundred and one of cerebrovascular stroke patients were assessed in the first week of symptoms by National Institutes of Health Stroke Scale (NIHSS) Arabic version, Mann Assessment of Swallowing Ability (MASA), cough challenge test, cough flow meter, and A2DS2 score. Then, follow up after 1 week.ResultsPost-stroke respiratory infection was higher in older patients and those who were not working. Respiratory infection was significantly associated with high A2DS2 and NIHSS score (p value < 0.001). A highly significant increase in the levels of the inflammatory markers was detected in patients with a respiratory infection. Eighty percent of stroke patients with no cough developed a respiratory infection. The Mann total scores and the peak cough flow were lower in patients who had a respiratory infection.ConclusionPreserved cough reflex is essential in preventing aspirations and consequent respiratory infections.

Abstract TP39: Comparative Effectiveness of Endovascular Treatment for Acute Ischemic Stroke: A Population-Based Analysis

Background: A heterogeneous patient population receives endovascular treatment (EVT) for acute ischemic stroke due to proximal large vessel occlusion every day. We aimed to conduct a population-based study of EVT in the province of Alberta, Canada, to understand the effectiveness in a complete population and how the magnitude of effect differs from the artificial world of clinical trials. Methods and Results: Within a three year period (April 2015 - March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. Primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at pre-morbid living situation without increase in level of care within 90 days of index stroke event. Median age of patients was 70 years (interquartile range (IQR) 59 - 81) and 47.8% were female. Median National Institutes of Health Stroke Scale (NIHSS) score was 17 (IQR 13 - 20). EVT was associated with an increased 90-day home-time by an average of 8.5 days compared to medical treatment alone using Cragg hurdle regression (p = 0.009). Age and higher NIHSS score were associated with decreased 90-day home-time (both p = 0.001). Multivariable logistic regression showed no association between EVT and mortality at 90 days (odds ratio 0.76, 95% confidence interval 0.47 - 1.24). Conclusions: EVT for acute ischemic stroke due to proximal large vessel occlusion was effective in our province-wide population-based study and results in increased 90-day home-time by ~8.5 days. Home-time is a novel and patient-centered outcome that reflects health circumstances that are easy to understand and meaningful to patients and their caregivers.

Distribution of Cardioembolic Stroke: A Cohort Study

Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this initiative, the so-called Parelsnoer Institute-Cerebrovascular Accident Study Group, clinical data, imaging, and biomaterials of patients with stroke are prospectively and uniformly collected. We compared the proportions of posterior stroke location in patients with a cardiac stroke source with those with another stroke etiology and calculated risk ratios (RR) with corresponding 95% CI with Poisson regression analyses. To assess which patient or disease characteristics were most strongly associated with a cardiac etiology in patients with ischemic stroke, we performed a stepwise backward regression analysis. Results: For the primary aim, 1,428 patients were eligible for analyses. The proportion of patients with a posterior stroke location among patients with a cardiac origin of their stroke (28%) did not differ statistically significant to those with another origin (25%), age and sex adjusted RR 1.16; 95% CI 0.96–1.41. For the secondary aim, 1,955 patients were eligible for analyses. No recent history of smoking, no hyperlipidemia, coronary artery disease, a higher age, and a higher National Institutes of Health Stroke Scale (NIHSS) score were associated with a cardiac etiology of ischemic stroke. Conclusions: We could not confirm our hypothesis that thromboembolic stroke localized in the posterior circulation is associated with a cardioembolic source of ischemic stroke, and therefore posterior stroke localization on itself does not necessitate additional cardiac examination. The lack of determinants of atherosclerosis, for example, no recent history of smoking and no hyperlipidemia, coronary artery disease, a higher age, and a higher NIHSS score are stronger risk factors for a cardiac source of ischemic stroke.

High serum S-100B protein levels within the first 36 hours of acute ischemic stroke predicts high NIHSS scores

Aim: The aim of the present study was to evaluate serum levels of S-100B which is an acidic calcium-binding protein within the first 36 hours following an acute ischemic stroke and to determine the correlation between S-100B levels and National Institutes of Health Stroke Scale (NIHSS) scores. Material and Methods: Fifty patients with ischemic stroke (25 male, 25 female; mean age=64) and 30 healthy volunteers (14 male, 16 female; mean age=61) serving as age and sex matched controls were included in this study. Venous blood samples were taken within the first 36 hours following the acute stroke. The quantitative determination of S-100B in serum was carried out using an enzyme linked immunosorbent assay.Results: Patients with acute ischemic stroke had significantly higher serum S-100B protein concentrations (42 pg/ml) than those of normal controls (31.5 pg/ml) (p0.001). S-100B concentrations were correlated with NIHSS scores (r=0.443; p=0.001), which is considered an indicator of the degree of neurological deficit.Conclusion: The present study demonstrates that S-100B concentrations in both the large artery atherosclerosis (LAA), cardio embolic infarct (CEI) subtypes of acute stroke are increased in the early phases of stroke and are correlated with NIHSS scores upon admission. S-100B appears to be a valuable biomarker of ongoing brain injury.

Study on the relationship of National Institutes of Health Stroke Scale score with heart rate variability and cardiac complication in elderly patients with acute cerebral infarction

Objective To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score. Methods One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups. Results In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05). Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke. Key words: Cerebral infarction; Heart rate; Autonomic agents

Negative-FLAIR vascular hyperintensities serve as a marker of no recanalization during hospitalization in acute stroke

BackgroundSince acute fluid-attenuated inversion recovery vascular hyperintensity (FVH) is indicative of disordered blood flow, FVH is considered a marker of acute major arterial occlusion. Conversely, the role of the absence of FVH (negative-FVH) remains unknown. MethodsConsecutive stroke patients were studied via magnetic resonance angiography, within 24 h of onset and major arterial occlusion. All patients were examined using serial angiography to evaluate the presence of recanalization. Patients were classified into negative-FVH and positive-FVH groups. ResultsA total of 72 patients (49 [68%] male patients, aged 76 [66–83] years) were enrolled. Ten patients were allocated to the negative-FVH group and 62 to the positive-FVH group. Initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (2–8) in the negative-FVH group and 10 (4–21) in the positive-FVH group (p = 0.012). Recanalization was achieved in 1 (10%) of the 10 patients in the negative-FVH group and in 49 (79%) of the 62 patients in the positive-FVH group during hospitalization (p < 0.001). Patients with recanalization were older (p = 0.023), had higher NIHSS score (p = 0.008), were admitted earlier (p = 0.014), exhibited a higher prevalence of atrial fibrillation (p = 0.010) and anterior circulation occlusion (p = 0.021), and were more frequently treated with hyperacute recanalization therapy (p = 0.004). Multivariate regression analysis demonstrated that negative-FVH (odds ratio 0.087, 95% confidential interval [0.008–0.988], p = 0.049) was a negative independent factor associated with recanalization during hospitalization. ConclusionsIn conclusion, negative-FVH in acute stroke was associated with lack of recanalization during hospitalization.

Evaluation of inflammatory markers and mean platelet volume as short-term outcome indicators in young adults with ischemic stroke

BackgroundStudying outcome predictors in patients with onset of cerebral infarction in early adult life may enhance our knowledge of disease pathophysiology and prognosis.AimThe aim is to identify independent predictors of short-term outcome of first-ever ischemic stroke in young adults with special emphasis on inflammatory and thrombogenic markers.MethodsWe enrolled 33 patients aged 19–44 years with first-ever ischemic stroke admitted to Kasr Alainy Stroke Unit and 33 matched controls. Clinical, radiological, and laboratory (adhesion molecules, C-reactive protein, prolactin, and mean platelet volume) evaluations were carried out. Functional outcome at 7 days after stroke onset was assessed using the modified Rankin scale, and independent predictors were identified.ResultsThe most frequently identified risk factor was cardiac abnormality. Patients exhibited significantly higher levels of baseline inflammatory and thrombogenic markers compared with controls. These markers were significantly correlated with the stroke severity. Logistic regression model showed that high National Institutes of Health Stroke Scale (NIHSS) score (odds ratios [OR] = 0.13; 95% confidence interval [CI], 0.04–0.24; P = 0.01) and large infarction size (OR = 0.11; 95% CI, 0.09–0.17; P = 0.04) but not the laboratory markers were independent predictors of unfavorable outcome.ConclusionOur data suggested that higher NIHSS scores and large infarction size served as independent predictors of short-term unfavorable outcome, while inflammatory and thrombogenic markers did not.

The Correlation between Atrial Fibrillation and Prognosis and Hemorrhagic Transformation

Objective: Atrial fibrillation (AF) is the recognized risk factor for hemorrhagic transformation (HT) in thrombolysis patients with acute ischemic stroke (AIS). But the impact of AF on prognosis is still controversial. In our study, we aimed to assess the relationship between AF and HT and prognosis. Methods: We assessed 184 patients diagnosed with AIS and received thrombolysis from January 2016 to October 2017. Based on the imaging results during hospitalization, the patients were divided into HT and non-HT groups in which the HT was containing 40 patients. According to the modified Rankin Scale (mRS), we divided the patients into favorable prognosis (mRS score of 0–2) and the poor (mRS score >2) after 3 and 6 months of follow-up. Our analysis included demographics, onset to treatment time, initial blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, HT, anticoagulants, AF, smoking, and other past history. Results: At baseline, there was a significant difference (p < 0.05) between the HT and non-HT groups in the level of age, hyperlipidemia, AF, NIHSS, and the application of anticoagulants. After 3 and 6 months of follow-up, we found that only NIHSS (OR_{3 month} 1.421, 95% CI 1.280–1.578, p < 0.001, and OR_{6 month} 1.326, 95% CI 1.217–1.445, p < 0.001) was associated with prognosis instead of AF, HT, and anticoagulants. Meanwhile, patients with AF tended to be older, higher NIHSS score and less hyperlipidemia (p < 0.05). Conclusion: The present study indicated that there is no significant correlation between AF and prognosis, although there is some indeed related with HT. That was, the prognosis with AF had a similar response trend compared with the non-AF.

Prevalence of aphasia after stroke in a hospital population in southern Brazil: a retrospective cohort study

ABSTRACTBackground: Aphasia negatively impacts quality of life. This is the first Brazilian study that investigates the prevalence of aphasia and its related factors, the results of which may underpin hospital and health service planning for this vulnerable population.Objective: To establish the prevalence of aphasia in patients after first-ever ischemic stroke (FEIS) and associated factors.Methods: This is a retrospective cohort study, based on a database held in Joinville, Brazil. All cases of FEIS admitted to one public hospital in Joinville in 2015 were selected. The diagnosis of aphasia was verified by neurologists through the language item of the National Institute of Health Stroke Scale (NIHSS).Results: Of the 350 patients with FEIS, 79 (22.6%) had aphasia. Patients with aphasia (PWA) were older, with a higher likelihood of dysarthria, more thrombolytic use, and greater stroke severity. PWA had higher mortality than patients without aphasia (24.1% versus 10.7%, p = .004) and longer hospitalization time (21.32 versus 17.46 days, p = .009). Higher NIHSS score was an independent predictor for the occurrence of aphasia on admission (OR 1.24, 95% CI 1.17–1.31, p < .001). Older age (OR 1.06, 95% CI 1.03–1.09, p < .001) and stroke severity by NIHSS (OR 1.19, 95% CI 1.12–1.25, p = <0.001) were independent predictors of death.Conclusions: PWA may need more health care during hospitalization, because of the severity of the stroke, and their frailty. Further studies are needed to assess the direct impact of aphasia on inpatients.

Does the nutritional status of acute stroke patients affect the neurological status in the early post-stroke period?

ABSTRACTAccording to recent reports, malnutrition may be associated with a worse prognosis in stroke patients. The aim of this study was to determine the nutritional status of stroke patients and its impact on neurological and functional status of patients in the early post-stroke period. Our prospective study included a total of 128 patients admitted to the Stroke Unit. The assessment was made in the patients within the first week after the onset of stroke symptoms. Groups of patients with abnormal body mass index (BMI <20kg/m2 or >25kg/m2) were compared to the group of normal BMI, serum albumin, total cholesterol, HDL and LDL levels were determined in each patient within 24h following admission. The analysis showed that the patients with lower levels of serum albumin and triglycerides had higher scores in the National Institutes of Health Stroke Scale (NIHSS) on admission. Patients with a higher risk of malnutrition, confirmed by the Subjective Global Assessment scale, had higher NIHSS scores. The study showed a positive relationship between the nutritional status and worse neurological status of patients in the early post-stroke period.Abbreviation: NIHSS; Rankin scale

Neurological Deficits in Stroke Patients that May Impede the Capacity to Provide Informed Consent for Endovascular Treatment Trials

BackgroundWe assessed the occurrence of neurological deficits that may impede the capacity to provide consent for trial participation in patients with an acute stroke, who are eligible for endovascular treatment (EVT). MethodsWe used data from the Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective observational cohort study. We included 1526 patients with an anterior large vessel occlusion, undergoing EVT between March 2014 and June 2016. We based our assessment of decision-making capacity for trial participation on neurological symptoms influencing conditions concerning informed consent as stated in the declaration of Helsinki. We formulated a strict and a mild capacity assessment rule, using 2 different cut points in item scores on the National Institutes of Health Stroke Scale (NIHSS). ResultsApplying the strict and mild rule, respectively 1469 (96%) and 1220 (80%) patients deemed not capable of decision-making for trial participation on admission, and 1077 (79%) and 825 (60%) patients at 24-48 hours after admission. Highest frequencies of predefined scores suggesting incapacity based on the strict rule were on the NIHSS items “Level of Consciousness Questions” (59%), "Best Gaze" (68%), and “Best Language” (58%). Patients who were considered incapable were older (median 71 versus 66 years, P = .043), had higher NIHSS scores (median 16 versus 8, P < .001), and had more often left hemisphere strokes (55% versus 28%, P < .001) than patients who were presumably capable. ConclusionsIn the majority of patients with an anterior circulation stroke who are eligible for EVT, neurological deficits are present that may impede the capacity to provide informed consent for trial participation.

Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort.

Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29–0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23–0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.

Who Is Classified as Untestable on Brief Cognitive Screens in an Acute Stroke Setting?

Full completion of cognitive screening tests can be problematic in the context of a stroke. Our aim was to examine the completion of various brief cognitive screens and explore reasons for untestability. Data were collected from consecutive stroke admissions (May 2016–August 2018). The cognitive assessment was attempted during the first week of admission. Patients were classified as partially untestable (≥1 test item was incomplete) and fully untestable (where assessment was not attempted, and/or no questions answered). We assessed univariate and multivariate associations of test completion with: age (years), sex, stroke severity (National Institutes of Health Stroke Scale (NIHSS)), stroke classification, pre-morbid disability (modified Rankin Scale (mRS)), previous stroke and previous dementia diagnosis. Of 703 patients admitted (mean age: 69.4), 119 (17%) were classified as fully untestable and 58 (8%) were partially untestable. The 4A-test had 100% completion and the clock-draw task had the lowest completion (533/703, 76%). Independent associations with fully untestable status had a higher NIHSS score (odds ratio (OR): 1.18, 95% CI: 1.11–1.26), higher pre-morbid mRS (OR: 1.28, 95% CI: 1.02–1.60) and pre-stroke dementia (OR: 3.35, 95% CI: 1.53–7.32). Overall, a quarter of patients were classified as untestable on the cognitive assessment, with test incompletion related to stroke and non-stroke factors. Clinicians and researchers would benefit from guidance on how to make the best use of incomplete test data.

Long-term prognosis of patients with stroke associated with middle cerebral artery occlusion. Single-centre registration study

IntroductionLarge artery intracranial occlusive disease including middle cerebral artery (MCA) is a major contributor to the incidence of stroke in China. The data on the prognosis of symptomatic atherosclerotic MCA occlusions (MCAO) are limited. We aimed to investigate the related factors of unfavorable outcomes in patients with stroke associated with MCAO.Material and methodsA total of 119 patients with MCAO symptom were enrolled in this retrospective longitudinal cohort study. All patients met inclusion criteria of cerebral angiography by CT angiography or magnetic resonance angiography. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).ResultsWe showed an average follow-up time of 46.8 months, within which 20 (19.6%) cases died and 14 (13.7%) cases had stroke recurrence. Using mRS as an evaluation index, the patients were divided into an unfavourable outcome group (mRS > 2, 48 cases) and a favourable outcome group (mRS ≤ 2, 54 cases). Logistic regression analysis suggests that age and NIHSS score were independent risk factors for a poor outcome value. Coexisting other cerebral vascular occlusion was an independent risk factor for stroke recurrence. Age was an independent risk factor for death.ConclusionsThe prognosis of patients with MCAO was generally optimistic, with higher survival rate and longer survival time. As compared, elder age and higher NIHSS score both tend to be associated with worse prognosis of survival. MCAO patients with other extracranial or intracranial vascular occlusion have higher risk of recurrent stroke. Death rate increases with age among the MCAO patients.

Long-term outcome and prognostic factors of posterior circulation ischemia patients: Results from a single center retrospective study.

Objective This study was to assess the clinical features and prognostic factors of posterior circulation cerebral infarction (PCCI) patients. Methods A total of 165 PCCI patients who were admitted to the Department of Neurology, Beijing Friendship hospital, Capital Medical University between January 2016 and December 2016 were included. Patients had complete medical record and received 12-month follow-up. The demographics, risk factors, clinical manifestations, National Institutes of Health Stroke Scale (NIHSS) score and imaging findings were collected and factors affecting their prognosis were further analyzed. Results The mean age was 59.5 ± 10.8 years and the mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 6.6 ± 2.8. The one-year recurrence rate of stroke was 6.7%; 84.8% of patients had good prognosis (modified Rankin Scale [mRS] score 0–3) and 15.2% had poor prognosis (mRS score &gt;3). The one-year mortality was 3.0%. Patients with ≥50% stenosis in the basilar artery and higher NIHSS score were more likely to have poor outcome. Conclusion The majority of PCCI patients have a good prognosis and a low mortality. The prognosis is poor in patients with ≥50% stenosis in the basilar artery and higher NIHSS score on admission.

The study of hyponatremia in the prognosis of acute ischemic stroke

Background: Stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Acute ischemic stroke is the fourth leading cause of death and most common cause of long-term disability worldwide. Hyponatremia is the commonest electrolyte disturbance encountered in the neurological intensive care units. This study investigated to evaluate hyponatremia in acute ischemic stroke patients as a reliable prognostic marker on admission to ICU.Methods: A total of 150 patients admitted to M S Ramaiah Hospitals during the period of October 2014 to September 2016 who fulfilled the inclusion criteria were considered in the study. All patients were evaluated by neurologist/ physician and the diagnosis of Acute ischemic stroke was made by Clinical examination and confirmed by Computed Tomography (CT) and/ Magnetic resonance imaging (MRI) brain. Hyponatremia was defined as serum sodium level &lt;135 mmol/L and recorded on admission. Outcome was assessed by National Institute of Health Stroke Scale (NIHSS) score at admission, day 5 and at discharge, duration of ICU stay, duration of hospital stay and in-patient mortality.Results: Among the 150 patients admitted with acute ischemic stroke, mean age was 60 years, 68% were males and 36% patients had hyponatremia. Baseline characteristics were similar between groups except for gender distribution (p=0.037). Hyponatremic patients had higher NIHSS score on admission, on day 5 and at discharge (p=&lt;0.001). Hyponatremic patients had a longer duration of ICU stay (p=&lt;0.001) and in hospital stay (p=&lt;0.001). Hyponatremia was associated with higher mortality in hospital (p=0.026).Conclusions: Study demonstrates that hyponatremia at admission in acute ischemic stroke patients is associated with acute mortality, worse NIHSS score at admission and at discharge, and longer duration of ICU and hospital stay.