Prognosis

Many patients die ^b though the risk is lower with a minor stroke or TIA. ^a 
The risk of dying following a stroke is increased with: ^b  

• increasing age 
• drowsy or comatose at first examination 
• fever or hypothermia on admission 
• an elevated glucose on admission particularly if no known diabetes mellitus 

The risk of dying after 30 days is increased with  ^a

• a previous TIA
• pre-stroke functional disability 
• a history of intermittent claudication
• urinary incontinence 

• increasing age ^{a b}
• a severe ^a  or worsening stroke ^b  
• atrial fibrillation ^{a b}  
• ischaemic heart disease (particularly if an early onset) ^b or intermittent claudication ^b  
• smoking ^a  
• heart failure ^b 
• an elevated glucose on admission ^a  
• an elevated CRP (> 33 mg/dl) on admission ^a
• urinary incontinence ^b  
• unpartnered marital status ^b  

Score your patient for the following features

Clinical feature on admission b	score
impaired consciousness	5
urinary incontinence	4
dysphagia	3
body temperature < 36.5°C	2
hyperglycaemia but no history of diabetes	2

Determine your patient's risk of dying

Score b	% dead at 30 days (95% CI)
11 or more	68% (48% to 89%)
< 11	5.1% (2.0% to 8.1%)

The risk of dying following a TIA or minor stroke is increased with: ^a  

• increasing age ^a  
• diabetes mellitus ^a  
• atrial fibrillation ^a  
• ischaemic heart disease ^a  or intermittent claudication ^a  
• hypercholesterolaemia  ^a  
• minor disability ^a,  including dysarthria ^a,  cranial nerve palsy ^a or limb weakness ^a  
• seizures in hospital, or altered consciousness ^a
• intraventricular haemorrhage  ^a  
• vomiting ^a  

• ventricular extension 
• intracerebral haemorrhage volume ≥ 30 cm³ 
• an initial GCS < 12

Deterioration

Many patients with stroke will get worse over the next few days ^b  
The risk of early deterioration is increased with: ^b  

• posterior circulation stroke
• reduced level of consciousness
• hypertension

• high systolic blood pressure at admission
• carotid vascular territory involvement 
• elevated initial glycaemia 

• ventricular extension
• intracerebral haemorrhage volume ≥ 30 cm³ 

Functional outcome

• increasing age ^{a b}
• atrial fibrillation  ^a  
• a severe deficit  ^{a b}
• bilateral or right-sided-stroke ^b
• urinary incontinence ^{a b}
• dysphagia ^b
• pre-stroke institutionalisation ^a
• no committed caregiver ^b

• no apraxia 
• normal muscle strength 
• a desk job

Dementia

Depression

Dysphagia

Dysphagia, chest infection or aspiration are more likely with: ^a  

• penetration of food
• delayed oral transit
• increasing age
• male sex
  

Recurrence

• increasing age ^b  
• a prior stroke ^a  
• diabetes mellitus ^{a b}  or elevated glucose levels on admission ^a  
• hypertension at discharge ^a  
• heavy alcohol use ^a  
• a patent foramen ovale and atrial septal aneurysm ^a

• increasing age ^a  
• recurrent minor strokes or a lacunar stroke ^a  
• diabetes mellitus ^a  
• hypertension ^a  
• a prior MI ^a  
  

Seizures

• a cortical involvement ^b  
• an acute agitated confusional state ^b  
• an anterior hemisphere infarct ^b  

A few patients will go on to have late seizures ^b  
The risk of seizures is increased with:

• a haemorrhagic first stroke ^b  
• seizure onset within 24 hours of stroke ^b
• recurrent stroke ^b

The risk of status epilepticus is increased with

• a poor functional status ^b

Urinary incontinence

Urinary incontinence is common initially, but settles in most patients. ^a
The risk is increased with ^a

• old age
• a subarachnoid haemorrhage
• dysphagia
• visual field defect
• motor weakness

and reduced following a lacunar infarct. ^a