Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Acta Neurol Scand. 2019 Feb;139(2):143-149. doi: 10.1111/ane.13029. Epub 2018 Oct 5.
We aimed to evaluate factors associated with neurological worsening among patients with lacunar or non-lacunar infarction admitted within 3 hours and between 3 and 24 hours after stroke onset.
All patients admitted to Haukeland university hospital between 2006 and 2016 with acute cerebral infarction on MRI and admission within 24 hours were included. Repeated National Institute of Health Stroke Scale (NIHSS) scoring was performed in all patients whenever possible. Neurological worsening during the hospital stay was defined as NIHSS score increase ≥3 compared to NIHSS score on admission.
In patients with lacunar infarction admitted within 3 hours of onset, neurological worsening was associated with low NIHSS score on admission, low body temperature, and leukoaraiosis, whereas only internal carotid artery stenosis or occlusion was associated with neurological worsening in non-lacunar infraction. For patients admitted 3-24 hours after onset, neurological worsening was associated with low body temperature, high systolic blood pressure, and short time from onset to admission in patients with lacunar infarction, whereas high systolic blood pressure, high NIHSS score on admission, middle cerebral artery occlusion, and high blood glucose were associated with neurological worsening in patients with non-lacunar infarction (all P < 0.05).
Lacunar infarctions with minor neurological deficits within 3 hours of stroke onset are at high risk of neurological worsening especially if concomitant low body temperature and leukoaraiosis.
我们旨在评估在发病后 3 小时内和 3 至 24 小时内入院的腔隙性或非腔隙性梗死患者中与神经功能恶化相关的因素。
所有于 2006 年至 2016 年期间因 MRI 显示急性脑梗死且于 24 小时内入院的患者均纳入本研究。所有患者均尽可能重复进行国立卫生研究院卒中量表（NIHSS）评分。住院期间神经功能恶化定义为与入院时 NIHSS 评分相比增加≥3 分。
在发病 3 小时内入院的腔隙性梗死患者中，神经功能恶化与入院时 NIHSS 评分低、低体温和白质疏松症有关，而非腔隙性梗死患者中仅颈内动脉狭窄或闭塞与神经功能恶化有关。对于发病后 3-24 小时入院的患者，腔隙性梗死患者中体温低、收缩压高、发病至入院时间短与神经功能恶化相关，而非腔隙性梗死患者中收缩压高、入院时 NIHSS 评分高、大脑中动脉闭塞和高血糖与神经功能恶化相关（均 P<0.05）。
发病 3 小时内神经功能缺损较小的腔隙性梗死患者尤其容易出现神经功能恶化，特别是如果伴有低体温和白质疏松症。
