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Haruko Yamamoto, MD; Julien Bogousslavsky, MD, PhD; Guy van Melle, PhD

Arch Neurol. 1998;55:481-486.

Objectives  To investigate clinical determinants of neurological worsening and to delineate its predictors.

Design  Restrospective analysis of the data from the Lausanne Stroke Registry.

Patients  A total of 3038 patients with first-ever stroke consecutively admitted to a primary-care stroke center.

Main Outcome Measures  Neurological worsening in the acute phase of stroke.

Results  Neurological worsening was observed in 38% of 300 patients with brain hemorrhage, 34% of 1968 patients with noncardioembolic infarction, and 15% of 770 patients with cardioembolic infarction (P<.001). Neurological worsening was significantly less frequent in patients with small-artery disease than in those with large-artery atherosclerosis or other causes. A logistic multiple regression model in patients with noncardioembolic infarction showed age less than 65 years, hypertension, lesion outside the superficial anterior circulation, absence of transient ischemic attack, and reduced level of consciousness as the independent factors in the patients with small-artery disease, while it showed involvement of the posterior circulation and reduced level of consciousness in the patients with large-artery atherosclerosis. Severe functional disability or death was more common in patients with neurological worsening, both in patients with large-artery atherosclerosis and in those with small-artery disease (18% vs 9%; P<.001).

Conclusions  Determinants of neurological worsening may include causative aspects rather than just the evolution of the ischemic or hemorrhagic process itself. For a better comprehension and treatment of neurological worsening, the causative and pathophysiological conditions underlying stroke should be differentiated as early as possible.

From the Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

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