This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (27)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Cerebrovascular Disease  • Alert me on articles by topic

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.

RELATED ARTICLE

Stroke 1998
Roger N. Rosenberg
Arch Neurol. 1998;55(4):448.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management
Thanvi et al.
Postgrad. Med. J. 2008;84:412-417.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Adams et al.
Circulation 2007;115:e478-e534.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Adams et al.
Stroke 2007;38:1655-1711.
ABSTRACT | FULL TEXT  

Specific DWI lesion patterns predict prognosis after acute ischaemic stroke within the MCA territory
Bang et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1222-1228.
ABSTRACT | FULL TEXT  

Neurologic Worsening During the Acute Phase of Ischemic Stroke
Weimar et al.
Arch Neurol 2005;62:393-397.
ABSTRACT | FULL TEXT  

Ischemic Preconditioning From Transient Ischemic Attacks?: Data From the Northern California TIA Study
Johnston
Stroke 2004;35:2680-2682.
ABSTRACT | FULL TEXT  

Prediction of Neurologic Deterioration in Patients with Lacunar Infarction in the Territory of the Lenticulostriate Artery Using Perfusion CT
Yamada et al.
Am. J. Neuroradiol. 2004;25:402-408.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association
Adams et al.
Stroke 2003;34:1056-1083.
FULL TEXT  

Progressive Stroke, Lacunae, and Systemic Blood Pressure
Bergui et al.
Stroke 2002;33:2735-2736.
FULL TEXT  

Worsening in Ischemic Stroke Patients: Is it Time for a New Strategy?
Caplan
Stroke 2002;33:1443-1445.
FULL TEXT  

Lacunar Stroke Is the Major Cause of Progressive Motor Deficits
Steinke and Ley
Stroke 2002;33:1510-1516.
ABSTRACT | FULL TEXT  

Inflammation-Mediated Damage in Progressing Lacunar Infarctions: A Potential Therapeutic Target
Castellanos et al.
Stroke 2002;33:982-987.
ABSTRACT | FULL TEXT  

Neurological Deterioration in Acute Lacunar Infarctions : The Role of Excitatory and Inhibitory Neurotransmitters
Serena et al.
Stroke 2001;32:1154-1161.
ABSTRACT | FULL TEXT  

Deteriorating Ischemic Stroke in 4 Clinical Categories Classified by the Oxfordshire Community Stroke Project
Tei et al.
Stroke 2000;31:2049-2054.
ABSTRACT | FULL TEXT  

Deterioration Following Spontaneous Improvement : Sonographic Findings in Patients With Acutely Resolving Symptoms of Cerebral Ischemia
Alexandrov et al.
Stroke 2000;31:915-919.
ABSTRACT | FULL TEXT  

Attenuated Stroke Severity After Prodromal TIA : A Role for Ischemic Tolerance in the Brain?
Weih et al.
Stroke 1999;30:1851-1854.
ABSTRACT | FULL TEXT  

Stroke 1998
Rosenberg
Arch Neurol 1998;55:448-448.
FULL TEXT