Journal Article

Characteristics and Outcome of Ischemic Stroke Patients Who Are Free of Symptoms at 24 Hours following Thrombolysis

Piironen, Katja, Tatlisumak, Turgut, Atula, Sari, Strbian, Daniel, Sairanen, Tiina, Soinne, Lauri, Rantanen, Kirsi

2011

Overview

Background: A part of ischemic stroke patients score 0 on the National Institutes of Health Stroke Scale (NIHSS) within 24 h following thrombolysis. Their clinical characteristics and long-term outcome are poorly studied. We report a single-center assessment of such patients. Methods: The cohort comprises 874 consecutive patients from the Helsinki Stroke Thrombolysis Registry, out of whom 113 scored 0 on 24-hour NIHSS. We analyzed their baseline demographic, clinical and radiological characteristics and 3-month outcome (modified Rankin Scale, mRS). Associations between the study parameters were tested by multivariate analysis. Results: Patients with a 24-hour NIHSS score = 0 (n = 113) were younger than the rest of the population (n = 761; median: 65.6 vs. 71.5 years; p < 0.001), their NIHSS score on admission was lower (median: 5 vs. 10; p < 0.001), as was their glucose level (median: 6.2 vs. 6.7 mmol/l; p = 0.02). The onset-to-treatment time was similar in both groups (median: 120 vs. 115 min; p = 0.89). Patients with a 24-hour NIHSS score = 0 more often achieved an excellent outcome (mRS scores: 0–1; 81 vs. 31%; p < 0.001) and had lower mortality (1.8 vs. 11.8%; p < 0.01). One third of these patients had a brain infarction visible on 24-hour imaging. Lower baseline NIHSS score and younger age were independently associated with 24-hour NIHSS score = 0, which, in turn, was independently associated with excellent 3-month outcome. Conclusions: Patients with an NIHSS score = 0 at 24 h following thrombolysis are younger, have milder symptoms and have a lower glucose level on admission. They achieve more often excellent outcome and lower mortality. Still, 8% of them required help in daily activities or were dead at 3 months (mRS scores: 3–6).

• Publisher: S. Karger AG
• Subject: Age Factors / Aged / Blood Glucose - analysis / Brain Ischemia - diagnosis / Brain Ischemia - drug therapy / Brain Ischemia - mortality / Disability Evaluation / Female / Fibrinolytic Agents - administration & dosage / Finland / Humans / Logistic Models / Male / Middle Aged / Odds Ratio / Original Paper / Patient Admission / Registries / Risk Assessment / Risk Factors / Severity of Illness Index / Stroke - diagnosis / Stroke - drug therapy / Stroke - mortality / Thrombolytic Therapy / Time Factors / Tissue Plasminogen Activator - administration & dosage / Treatment Outcome