Neurological deterioration in patients with acute ischemic stroke or transient ischemic attack

Objective: To improve epidemiological knowledge of neurological deterioration (ND) in patients with acute ischemic stroke (AIS).

Methods: In this prospective observational study, we captured ND prospectively in 29,446 AIS patients admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurological symptoms. Change of incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) at 3 months and 1 year, and a composite of stroke, myocardial infarction and all-cause death at 1 year were assessed.

Results: ND occurred in 4299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence was within the first 6 hours which decreased to 2.09 within 24-48 hours, and 0.66 within 72-96 hours after stroke onset. Old age, women, diabetes, early arrival, large artery atherosclerosis as a strok...