Stroke: a third of patients had neurological worsening.
Clinical bottom line (level 2b-)
Nearly a third of patients with a first-ever stroke suffered neurological worsening.
About a third of patients who had a haemorrhagic or noncardioembolic first-stroke had neurological worsening, whereas only a sixth of patients with a cardioembolic stroke did.
Yamamoto et al:
Archives of Neurology
Retrospective cohort study
for confounding factors,
validated in an independent set of patients.
Setting: community-based, primary-care centre, Switzerland
range 16 to 97 years; mean 63,
first stroke (brain infarct or haemorrhage)
possible early recurrent stroke and deterioration of general condition
Intravenous continuous heparin was given for neurological worsening in patients with supposed thrombus propagation or cardioembolism, if there was no contraindication. Oral aspirin (200 mg/day) was given systemically to patients with ischaemic stroke but not under anticoagulation.
Logistic multiple regression analysis was performed to adjust for confounding factors.
worsening of neurological condition, including consciousness level, was observed by investigators at and after admission in care unit
neurological worsening with brain haemorrhage
neurological worsening with cardioembolic brain infarct
neurological worsening with noncardioembolic brain infarct
||time to outcome
||number of patients/total number
| neurological worsening
| neurological worsening with brain haemorrhage
| neurological worsening with cardioembolic brain infarct
| neurological worsening with noncardioembolic brain infarct
- In stroke caused by large-artery atherosclerosis, posterior circulation and reduced level of consciousness may be risk factors for neurological worsening.
- In stroke caused by small-artery disease, age >64 years, superficial anterior circulation and TIA may decrease the risk for neurological worsening, and hypertension and reduced level of consciousness may increase the risk.
- Risk factors for neurological factors were given as coefficients and not relative risks or odds ratios, so NNF+ could not be calculated.
Contributor: Clare Wotton and Musab Hayatli,
Different predictors of neurological worsening in different causes of stroke.
Archives of Neurology
Reviewer: Martin Mueller
|Intervention or Exposure
||haemorrhagic, embolic, predictors