Ischemic stroke natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Natural History

Complications

Common complications of ischemic stroke may include:[1][2][3][4]

Duration Complications
Early complications

( <7 days )

Late complications

( >7 days )

Prognosis

Prognosis of stroke depends on factors such as:[18][19][20][21][22][23][24]

  • Age of the patient
  • Location of infarct
  • Size and volume of infarct
  • Extent of neurological damage
  • Time to seek medical help
  • Comorbid conditions such as
  • Intevention such as thrombolysis
  • Quality of rehabilition care
  • Complications
Good prognostic factors Bad Prognostic factors
A Large size and volume of infarct[25]
A Severe neurological deficit[19][21][26][27][28][24]
A NIHSS score >=16[29][30]</ref>
A Location of the infarct[23][26][31][32][33][34]
  • Severe middle cerebral artery infarction[35][36][37]
  • Cervical internal carotid artery
  • Brainstem infarction
  • Anterior choroidal artery
A Presence of fever, cerebral edema, hyperglycemia[23][26][38][39]
A Presence of co morbid conditions[23][40]
  • Anemia
  • Myocardial infarction
  • Diabetes mellitus[40]
  • Atrial fibrillation
  • Malnutrition
  • Renal dysfunction[40][41]
  • Heart failure
  • Cancer
  • Coronary artery disease[23]
A Advanced age[21][42]
A Low socioeconomic status
A

References

  1. ↑ Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP (2011). "Processes of care and medical complications in patients with stroke". Stroke. 42 (1): 167–72. doi:10.1161/STROKEAHA.110.599738. PMID 21148436.
  2. ↑ Wira CR, Rivers E, Martinez-Capolino C, Silver B, Iyer G, Sherwin R; et al. (2011). "Cardiac complications in acute ischemic stroke". West J Emerg Med. 12 (4): 414–20. doi:10.5811/westjem.2011.2.1765. PMC 3236132. PMID 22224130.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008). "Medical complications in a comprehensive stroke unit and an early supported discharge service". Stroke. 39 (2): 414–20. doi:10.1161/STROKEAHA.107.489294. PMID 18096834.
  4. ↑ 4.0 4.1 Minet LR, Peterson E, von Koch L, Ytterberg C (2015). "Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study". Stroke. 46 (9): 2688–90. doi:10.1161/STROKEAHA.115.010496. PMID 26243230.
  5. ↑ Ropper AH, Shafran B (1984). "Brain edema after stroke. Clinical syndrome and intracranial pressure". Arch Neurol. 41 (1): 26–9. PMID 6606414.
  6. ↑ Sherman DG, Easton JD (1980). "Cerebral edema in stroke: a common, often fatal complication". Postgrad Med. 68 (1): 107–13, 116, 119–20. PMID 6771748.
  7. ↑ 7.0 7.1 Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R (2005). "Dysphagia after stroke: incidence, diagnosis, and pulmonary complications". Stroke. 36 (12): 2756–63. doi:10.1161/01.STR.0000190056.76543.eb. PMID 16269630.
  8. ↑ Davenport RJ, Dennis MS, Warlow CP (1996). "Gastrointestinal hemorrhage after acute stroke". Stroke. 27 (3): 421–4. PMID 8610306.
  9. ↑ O'Donnell MJ, Kapral MK, Fang J, Saposnik G, Eikelboom JW, Oczkowski W; et al. (2008). "Gastrointestinal bleeding after acute ischemic stroke". Neurology. 71 (9): 650–5. doi:10.1212/01.wnl.0000319689.48946.25. PMID 18685137.
  10. ↑ Kamran SI, Downey D, Ruff RL (1998). "Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients". Neurology. 50 (6): 1683–8. PMID 9633711.
  11. ↑ Kelly J, Rudd A, Lewis RR, Coshall C, Moody A, Hunt BJ (2004). "Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging". Stroke. 35 (10): 2320–5. doi:10.1161/01.STR.0000140741.13279.4f. PMID 15322298.
  12. ↑ Dennis M, Mordi N, Graham C, Sandercock P, CLOTS trials collaboration (2011). "The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials". J Thromb Haemost. 9 (11): 2193–200. doi:10.1111/j.1538-7836.2011.04486.x. PMID 21883879.
  13. ↑ Amin AN, Lin J, Thompson S, Wiederkehr D (2013). "Rate of deep-vein thrombosis and pulmonary embolism during the care continuum in patients with acute ischemic stroke in the United States". BMC Neurol. 13: 17. doi:10.1186/1471-2377-13-17. PMC 3571887. PMID 23391151.
  14. ↑ 14.0 14.1 Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C; et al. (2000). "Medical complications after stroke: a multicenter study". Stroke. 31 (6): 1223–9. PMID 10835436.
  15. ↑ Korpelainen JT, Kauhanen ML, Kemola H, Malinen U, Myllylä VV (1998). "Sexual dysfunction in stroke patients". Acta Neurol Scand. 98 (6): 400–5. PMID 9875618.
  16. ↑ Senelick Richard C., Rossi, Peter W., Dougherty, Karla (1994). Living with Stroke: A Guide For Families. Contemporary Books, Chicago.
  17. ↑ Korpelainen JT, Nieminen P, Myllylä VV (1999). "Sexual functioning among stroke patients and their spouses". Stroke. 30 (4): 715–9. PMID 10187867.
  18. ↑ Faraji F, Ghasami K, Talaie-Zanjani A, Mohammadbeigi A (2013). "Prognostic factors in acute stroke, regarding to stroke severity by Canadian Neurological Stroke Scale: A hospital-based study". Asian J Neurosurg. 8 (2): 78–82. doi:10.4103/1793-5482.116378. PMC 3775186. PMID 24049549.
  19. ↑ 19.0 19.1 Holloway RG, Benesch CG, Burgin WS, Zentner JB (2005). "Prognosis and decision making in severe stroke". JAMA. 294 (6): 725–33. doi:10.1001/jama.294.6.725. PMID 16091575.
  20. ↑ Heinsius T, Bogousslavsky J, Van Melle G (1998). "Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns". Neurology. 50 (2): 341–50. PMID 9484351.
  21. ↑ 21.0 21.1 21.2 Matthews WB, Oxbury JM (1975). "Prognostic factors in stroke". Ciba Found Symp (34): 279–89. PMID 1045995.
  22. ↑ Hankey GJ (2013). "Stroke in young adults: implications of the long-term prognosis". JAMA. 309 (11): 1171–2. doi:10.1001/jama.2013.2319. PMID 23512064.
  23. ↑ 23.0 23.1 23.2 23.3 23.4 Dávalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J (1999). "Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I." Stroke. 30 (12): 2631–6. PMID 10582989.
  24. ↑ 24.0 24.1 Sumer MM, Ozdemir I, Tascilar N (2003). "Predictors of outcome after acute ischemic stroke". Acta Neurol Scand. 107 (4): 276–80. PMID 12675701.
  25. ↑ Schiemanck SK, Kwakkel G, Post MW, Prevo AJ (2006). "Predictive value of ischemic lesion volume assessed with magnetic resonance imaging for neurological deficits and functional outcome poststroke: A critical review of the literature". Neurorehabil Neural Repair. 20 (4): 492–502. doi:10.1177/1545968306289298. PMID 17082505.
  26. ↑ 26.0 26.1 26.2 Weimar C, Mieck T, Buchthal J, Ehrenfeld CE, Schmid E, Diener HC; et al. (2005). "Neurologic worsening during the acute phase of ischemic stroke". Arch Neurol. 62 (3): 393–7. doi:10.1001/archneur.62.3.393. PMID 15767504.
  27. ↑ Racosta JM, Di Guglielmo F, Klein FR, Riccio PM, Giacomelli FM, González Toledo ME; et al. (2014). "Stroke Severity Score based on Six Signs and Symptoms The 6S Score: A Simple Tool for Assessing Stroke Severity and In-hospital Mortality". J Stroke. 16 (3): 178–83. doi:10.5853/jos.2014.16.3.178. PMC 4200591. PMID 25328876.
  28. ↑ Heldner MR, Zubler C, Mattle HP, Schroth G, Weck A, Mono ML; et al. (2013). "National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke". Stroke. 44 (4): 1153–7. doi:10.1161/STROKEAHA.111.000604. PMID 23471266.
  29. ↑ Adams HP, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR; et al. (1999). "Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)". Neurology. 53 (1): 126–31. PMID 10408548.
  30. ↑ Frankel MR, Morgenstern LB, Kwiatkowski T, Lu M, Tilley BC, Broderick JP; et al. (2000). "Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial". Neurology. 55 (7): 952–9. PMID 11061250.
  31. ↑ Huttner HB, Schwab S (2009). "Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives". Lancet Neurol. 8 (10): 949–58. doi:10.1016/S1474-4422(09)70224-8. PMID 19747656.
  32. ↑ Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996). "'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs". Arch Neurol. 53 (4): 309–15. PMID 8929152.
  33. ↑ Treadwell SD, Thanvi B (2010). "Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management". Postgrad Med J. 86 (1014): 235–42. doi:10.1136/pgmj.2009.094292. PMID 20354047.
  34. ↑ Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Consoli D, Wolfe CD; et al. (2006). "Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project". J Neurol Sci. 244 (1–2): 143–50. doi:10.1016/j.jns.2006.01.016. PMID 16530226.
  35. ↑ Schiemanck SK, Kwakkel G, Post MW, Kappelle LJ, Prevo AJ (2008). "Impact of internal capsule lesions on outcome of motor hand function at one year post-stroke". J Rehabil Med. 40 (2): 96–101. doi:10.2340/16501977-0130. PMID 18509572.
  36. ↑ Abboud H, Berroir S, Labreuche J, Orjuela K, Amarenco P, GENIC Investigators (2006). "Insular involvement in brain infarction increases risk for cardiac arrhythmia and death". Ann Neurol. 59 (4): 691–9. doi:10.1002/ana.20806. PMID 16566012.
  37. ↑ Colivicchi F, Bassi A, Santini M, Caltagirone C (2005). "Prognostic implications of right-sided insular damage, cardiac autonomic derangement, and arrhythmias after acute ischemic stroke". Stroke. 36 (8): 1710–5. doi:10.1161/01.STR.0000173400.19346.bd. PMID 16020766.
  38. ↑ Bruno A, Biller J, Adams HP, Clarke WR, Woolson RF, Williams LS; et al. (1999). "Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators". Neurology. 52 (2): 280–4. PMID 9932944.
  39. ↑ Baird TA, Parsons MW, Phan T, Phanh T, Butcher KS, Desmond PM; et al. (2003). "Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome". Stroke. 34 (9): 2208–14. doi:10.1161/01.STR.0000085087.41330.FF. PMID 12893952.
  40. ↑ 40.0 40.1 40.2 Saposnik G, Kapral MK, Liu Y, Hall R, O'Donnell M, Raptis S; et al. (2011). "IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke". Circulation. 123 (7): 739–49. doi:10.1161/CIRCULATIONAHA.110.983353. PMID 21300951.
  41. ↑ Iseki K, Fukiyama K, Okawa Dialysis Study (OKIDS) Group (2000). "Clinical demographics and long-term prognosis after stroke in patients on chronic haemodialysis. The Okinawa Dialysis Study (OKIDS) Group". Nephrol Dial Transplant. 15 (11): 1808–13. PMID 11071969.
  42. ↑ Wijdicks EF, Diringer MN (1998). "Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome". Mayo Clin Proc. 73 (9): 829–36. doi:10.4065/73.9.829. PMID 9737218.


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