Stroke Unit, Careggi University Hospital, Florence, Italy.
Department of Neurological and Psychiatric Sciences, University of Florence, Italy.
J Stroke Cerebrovasc Dis. 2014 Feb;23(2):204-8. doi: 10.1016/j.jstrokecerebrovasdis.2012.11.018. Epub 2013 Jan 24.
Patients with an acute ischemic stroke rated as mild, and for this reason not submitted to thrombolysis, have an unfavorable outcome in a non-negligible proportion. Whether selective presentation features help identify those at risk of bad outcome, and whether it could be recommended to treat only patients with such features, is poorly elucidated. We report our experience based on retrospective evaluation of a consecutive series of patients scoring 6 or less on baseline National Institutes of Health Stroke Scale (NIHSS), some of whom received thrombolysis.
From the prospective Careggi Hospital Stroke Registry, Florence, Italy, we selected a series of patients who fulfilled the following criteria: (1) screening for treatment within 3 hours of symptom onset; (2) mild symptoms, defined as a score of 6 or less on NIHSS, with or without rapid improvement; (3) no other reason for exclusion from thrombolysis; (4) no previous disability; and (5) admission to the stroke unit. We choose a modified Rankin scale score of less than 2 to define a good 3-month functional outcome. We studied as potential outcome predictors: age, baseline NIHSS score, isolated aphasia, motor impairment with or without aphasia, thrombolysis, previous stroke or transient ischemic attack, and interactions between each of these factors and thrombolysis.
Between February 2004 and June 2011, 128 patients fulfilled the selection criteria: 47 (36.7%) received tissue plasminogen activator, 81 (63.3%) did not. At 3 months, of the 81 patients not receiving tissue plasminogen activator, 14 (17.3%) had an unfavorable outcome, compared with 6 (12.8%) among the 47 treated. Hemorrhagic complications or death occurred in neither group. Adjusting for major confounders and for thrombolysis, the presence of aphasia on early assessment proved the only independent predictor of worse outcome. NIHSS score variation showed no effect.
Aphasia is an early marker of unfavorable outcome in mild ischemic stroke patients. In these patients thrombolysis should be considered beyond the NIHSS scoring.
急性缺血性卒中患者被评定为轻度，且因此未接受溶栓治疗，在相当大的比例中预后不良。是否选择具有提示作用的特征有助于识别那些有不良预后风险的患者，以及是否可以建议仅对具有这些特征的患者进行治疗，目前还不清楚。我们报告了基于对连续系列基线 NIHSS（国立卫生研究院卒中量表）评分为 6 或更低的患者进行回顾性评估的经验，其中一些患者接受了溶栓治疗。
我们从意大利佛罗伦萨的 Careggi 医院卒中登记处选择了一系列符合以下标准的患者：（1）在症状发作后 3 小时内进行溶栓治疗筛查；（2）轻度症状，定义为 NIHSS 评分为 6 或更低，伴有或不伴有快速改善；（3）无其他溶栓治疗排除原因；（4）无既往残疾；（5）入住卒中单元。我们选择改良 Rankin 量表评分小于 2 来定义 3 个月的良好功能结局。我们研究了潜在的预后预测因素：年龄、基线 NIHSS 评分、孤立性失语、伴有或不伴有失语的运动障碍、溶栓治疗、既往卒中和短暂性脑缺血发作，以及这些因素与溶栓治疗之间的相互作用。
在 2004 年 2 月至 2011 年 6 月期间，有 128 名患者符合选择标准：47 名（36.7%）接受了组织型纤溶酶原激活物治疗，81 名（63.3%）未接受治疗。在未接受组织型纤溶酶原激活物治疗的 81 名患者中，有 14 名（17.3%）预后不良，而在接受治疗的 47 名患者中，有 6 名（12.8%）预后不良。两组均未发生出血性并发症或死亡。在调整主要混杂因素和溶栓治疗后，早期评估时出现失语是预后不良的唯一独立预测因素。NIHSS 评分变化无影响。
失语是轻度缺血性卒中患者预后不良的早期标志物。在这些患者中，应考虑在 NIHSS 评分之外进行溶栓治疗。
