Clinical neurological characteristics of ischemic stroke subtypes in acute phase

Authors

  • S. I. Shkrobot І. Horbachevsky Ternopil State Medical University, Ukraine,
  • N. R. Sokhor І. Horbachevsky Ternopil State Medical University, Ukraine,
  • L. S. Milevska-Vovchuk І. Horbachevsky Ternopil State Medical University, Ukraine,
  • I. Ya. Krynytska І. Horbachevsky Ternopil State Medical University, Ukraine,
  • M. I. Marushchak І. Horbachevsky Ternopil State Medical University, Ukraine,
  • L. V. Shkrobot І. Horbachevsky Ternopil State Medical University, Ukraine,
  • O. R. Yasnij І. Horbachevsky Ternopil State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.1.121952

Keywords:

stroke, acute phase, risk factors, treatment failure

Abstract

Objectives. The aim of the present study was to clarify clinical neurological characteristics and different ischemic stroke subtypes unfavorable course predictors in acute phase.

Material and Methods. 482 patients with different ischemic stroke subtypes were observed. Among them there were 125 (25.9 %) with cardioembolic infarct (CEI), 119 (24.7 %) with large artery atherosclerosis (LAAS) infarct, 122 (25.3 %) with lacunar stroke (LAC), 116 (24.1 %) with stroke of undetermined etiology (UDE). The comparative analysis of clinical picture was performed. The predictors of unfavorable course of acute phase were established.

Results. We have found out that severe neurological deficit, high mortality and the worst functional outcome during the first 14 days were observed in patients with CEI and LAAS. The highest frequency of early neurological deterioration (END) was detected at LAC (in 22.7 % of patients). There was a relationship between END and presence of transient ischemic attack (TIA) in past medical history, the level of systolic blood pressure (SBP) at the beginning of the disease and the degree of carotid arteries stenosis on the side of lesion. The patients with LAC had mild neurological deficit and better prognosis compared with other ischemic stroke subtypes. Among the clinical factors that have impact on the CEI, LAAS and UDE acute phase course were: the size of lesion, the level of consciousness on the 1st day, the baseline SBP, patient’s age. At LAAS, the presence of transient ischemic attack (TIA) in past medical history and low SBP in the onset of the disease (less than140 mm Hg) has an additional prognostic value for an unfavorable functional outcome. The severity of LAC in acute period depended on its localization and size. Localization of LAC in the internal capsule, thalamus and pons were characterized by the highest severity.

Conclusions. Clinical neurological features of ischemic stroke depend on its subtype and have some prognostic value for the course of different ischemic stroke subtypes in acute phase.

References

Tuttolomondo, A., & Pinto, A. (2014) Ischemic stroke subtypes and the implications for stroke management. Future Neurol., 9(6), 567–570. doi: org/10.2217/fnl.14.53

Ohira, T., Shahar, E., Chambless, L. E., Rosamond, W. D., Mosley, T. H. Jr., & Folsom, A. R. (2006) Risk Factors for Ischemic Stroke Subtypes. The Atherosclerosis Risk in Communities Study. Stroke, 37, 2493–2498. doi: 10.1161/01.STR.0000239694.19359.88

Arboix, A. (2015) Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases, 3(5), 418–429. doi: 10.12998/wjcc.v3.i5.418.

Sarchielli, P., Nardi, K., Chiasserini, D., Eusebi, P., Tantucci, M., Di Piero, V., et al. (2013) Immunological Profile of Silent Brain Infarction and Lacunar Stroke. PLoS ONE, 8(7), e68428. doi: 10.1371/journal.pone.0068428.

Grysiewicz, R. A., Thomas, K., & Pandey, D. K. (2008) Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin, 26(4), 871–95. doi: 10.1016/j.ncl.2008.07.003.

Feigin, V. L., Lawes, C. M., Bennett, D. A., & Anderson, C. S. (2003) Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol, 2(1), 43–53. doi: 10.1016/S1474-4422(03)00266-7

McGrath, E. R., Kapral, M. K., Fang, J., Eikelboom, J. W., Conghaile, A., Canavan, M., & O'Donnell, M. J. (2013) Association of atrial fibrillation with mortality and disability after ischemic stroke. MJ Neurology, 27, 81(9), 825–32. doi: 10.1212/WNL.0b013e3182a2cc15

Arboix, A., & Martí-Vilalta, J. L. (2009) Lacunar stroke. Expert Rev Neurother., 9(2), 179–96. DOI: 10.1586/14737175.9.2.179

Jones, S. B., Sen, S., Lakshminarayan, K., & Rosamond, W. D. (2013) Poststroke Outcomes Vary by Pathogenic Stroke Subtype in The Atherosclerosis Risk in Communities Study. Stroke, 44(8), 2307–2310. doi: 10.1161/STROKEAHA.113.000830.

Melkas, S., Laurila, J. V., Vataja, R., Oksala, N., Jokinen, H., Pohjasvaara, T., et al. (2012) Post-stroke delirium in relation to dementia and long-term mortality. Int J Geriatr Psychiatry, 27(4), 401–8. doi: 10.1002/gps.2733.

Downloads

How to Cite

1.
Shkrobot SI, Sokhor NR, Milevska-Vovchuk LS, Krynytska IY, Marushchak MI, Shkrobot LV, Yasnij OR. Clinical neurological characteristics of ischemic stroke subtypes in acute phase. Zaporozhye Medical Journal [Internet]. 2018Jan.31 [cited 2024Nov.13];(1). Available from: http://zmj.zsmu.edu.ua/article/view/121952

Issue

Section

Original research