The natural history of ischaemic stroke with mild or rapidly improving symptoms.

Janssen, J. (Jankje) (2014) The natural history of ischaemic stroke with mild or rapidly improving symptoms. thesis, Medicine.

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Abstract

Introduction: Ischaemic stroke is a sudden disturbance of the cerebral circulation which leads to tissue damage, resulting in focal neurologic deficit lacking rapid resolution. Every year, approximately 24,000 people in The Netherlands get a first ischaemic stroke. The only registered treatment for ischaemic stroke in Europe is intravenous thrombolysis (IVT) with recombinant Tissue-Type Plasminogen Activator. Unfortunately, many patients do not receive IVT. Mild or rapidly improving symptoms are frequently cited reasons for not giving IVT. This study investigates the natural history of ischaemic stroke in patients with mild or rapidly improving symptoms. The aims of this study are: (1) to investigate change in disability between admission and after three months of these patients (2) to assess their functional outcomes after three months, (3) to assess discharge destination and (4) to investigate predictors of unfavourable outcome after three months. Materials and methods: In this prospective cohort study we analysed all patients with ischaemic stroke or transient ischaemic attack (TIA) admitted to the emergency department (ED) between 1 January 2007 and 1 January 2013, who did not receive IVT solely because of mild or rapidly improving symptoms. In the ED a standardized study form was filled in by a neurologist or resident. The study form contained demographic data, the duration of symptoms, the National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score on admission, the contraindications for IVT and if the patient received IVT. After three months follow-up mRS scores were obtained by telephone interview. Medical records were used to obtain additional data and to check the data from the study forms. To investigate the change in disability and the outcome after three months we used the mRS. Discharged destination was obtained from medical records. Logistic regression was used to investigate possible predictors of unfavourable outcome (mRS2-6). Results: Of the 885 patients admitted with an ischaemic stroke within the eligible time to receive IVT, 148 (16.7%) patients did not receive IVT solely because of mild or rapidly improving symptoms. The mRS improved in a significant amount of patients between admission and three months later, (50.7%, p<0.001), 21.0% could not be discharged to their home and 34.5% had an unfavourable mRS score after three months. Female sex, unfavourable mRS on admission and higher NIHSS on admission were predicting of unfavourable outcome after three months. Conclusion: Our study shows that although patients improve after ischaemic stroke with mild or rapidly improving symptoms, a large amount of patients could not be discharged to their home and/or had an unfavourable outcome after three months. We found female sex, unfavourable initial mRS score and higher initial NIHSS score to be predicting of unfavourable outcome. Further studies are necessary to investigate IVT in this subgroup and to identify those patients with mild or rapidly improving symptoms who potentially benefit from IVT.

Item Type:	Thesis (Thesis)
Supervisor name:	Berg, dr. J.S.P. van den and department of Neurology and Isala Klinieken, Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:05
Last Modified:	25 Jun 2020 11:05
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2540

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