Clinical Predictors Of Early Neurological Deterioration In Patients With Acute Minor Ischemic Stroke

Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke.Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration >= 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of >= 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration.Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.