Naess H, Kurtz M, Thomassen L, Waje-Andreassen U
Department of neurology, Haukeland University Hospital, Bergen, Norway.
Centre for age-related medicine, Stavanger University Hospital, Stavanger, Norway.
Acta Neurol Scand. 2016 Jun;133(6):415-20. doi: 10.1111/ane.12477. Epub 2015 Sep 7.
To study time course of neurological deficits in patients with acute cerebral infarction admitted shortly after stroke onset.
Serial NIHSS scores were obtained whenever feasible in patients admitted because of cerebral infarction within 3 h of symptom onset. Patients receiving and not receiving thrombolysis were compared. Short-term outcome was defined as NIHSS score and modified Rankin score 7 days after stroke onset. The hyperacute phase was defined as the time between stroke onset and the 6- to 9-h interval after stroke onset, acute phase as the time between the 6- to 9-h interval and the 21 to 27-h interval, and the subacute phase as the time between the 21- to 27-h interval and 7 days after stroke onset.
Serial NIHSS scores were obtained in 552 patients within three hours of stroke onset. There was a significant improvement (P < 0.001) comprising 62% of the total improvement in the hyperacute phase. There was no significant improvement in the acute phase and a small significant improvement in the subacute phase (P < 0.01).
Our study demonstrates a hyperacute phase with rapid improvement probably due to early recanalization, an acute phase with no significant improvement and slow improvement in the subacute phase. Different pathophysiological mechanisms are likely involved in the different phases.
研究急性脑梗死患者在卒中发作后不久入院时神经功能缺损的时间进程。
对于症状发作3小时内因脑梗死入院的患者，只要可行，就获取连续的美国国立卫生研究院卒中量表（NIHSS）评分。比较接受和未接受溶栓治疗的患者。短期结局定义为卒中发作7天后的NIHSS评分和改良Rankin量表评分。超急性期定义为卒中发作至卒中发作后6至9小时之间的时间段，急性期定义为6至9小时之间至21至27小时之间的时间段，亚急性期定义为21至27小时之间至卒中发作后7天之间的时间段。
在552例患者卒中发作3小时内获取了连续的NIHSS评分。超急性期有显著改善（P<0.001），占总改善的62%。急性期无显著改善，亚急性期有小幅度显著改善（P<0.01）。
我们的研究表明，超急性期可能由于早期再通而迅速改善，急性期无显著改善，亚急性期缓慢改善。不同阶段可能涉及不同的病理生理机制。
