Kini Seema, Memon Faisal, Asgaonkar Dileep
Associate Professor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai; *Corresponding Author.
Senior Resident, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai.
J Assoc Physicians India. 2019 Apr;67(4):46-50.
Stroke is the fourth leading cause of disability worldwide. The present study was designed to assess functional disability in middle cerebral artery (MCA) territory ischemic stroke patients by applying standard scales for stroke severity, cognitive impairment, disability, dependency and depression. We also wanted to study whether baseline assessment predicts outcome at 1 month.
After institutional ethics committee approval, patients were enrolled from the inpatients of the Department of Medicine at Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai from July 2014 to December 2015. Various clinical parameters were recorded on admission. On day 5(±1) the National Institutes of health Stroke Scale (NIHSS), Mini Mental state examination (MMSE) were administered. On 1 month follow up, these were repeated along with Modified Rankin scale, Barthel's index (BI) and Hospital Anxiety and Depression Scale (HADS). Presence of certain risk factors for stroke were reviewed at 1 month.
75 patients were enrolled. There was a delay in reaching the hospital and therefore imaging, in a greater majority. Only 4% could be imaged within the first 3 hours. Mean NIHSS score at day-5 was 9 and at day-30 was 6. Thus it had significantly reduced over 1 month. The MMSE remain unchanged at day 5 and at day 30. Lower baseline MMSE scores correlated with poorer outcomes on NIHSS, BI and mRS at 1 month. Both BI and mRS at 1 month indicated that about 60% of the cases had poor outcome. Amongst 48 of the non-aphasic MCA strokes, 11(22.92%) had depression. An NIHSS score of 6 or above on day 5, predicted poor outcome at 1 month. Presence of aphasia, dominant lobe affection and female sex were associated with a higher disability at 1 month. Around 30% cases had at least 1 risk factor uncontrolled at 1 month follow-up.
Our findings show that disability assessment late in the first week after onset of stroke using NIHSS accurately forecast outcome at one month after onset of stroke. The MMSE too is not expected to change at 1 month. Those with aphasia are expected to have greater disability. Based on or study we recommend that stroke patients should be assessed with NIHSS and MMSE before discharge, to explain the prognosis of the patient. Also more intense counselling on controlling blood pressure and diabetes as well as abstinence from smoking should be undertaken routinely.
中风是全球第四大致残原因。本研究旨在通过应用中风严重程度、认知障碍、残疾、依赖和抑郁的标准量表，评估大脑中动脉（MCA）区域缺血性中风患者的功能残疾情况。我们还想研究基线评估是否能预测1个月时的预后。
经机构伦理委员会批准后，于2014年7月至2015年12月从孟买托皮瓦拉国立医学院和BYL奈尔慈善医院内科的住院患者中招募患者。入院时记录各种临床参数。在第5天（±1天）进行美国国立卫生研究院卒中量表（NIHSS）、简易精神状态检查（MMSE）。在1个月随访时，重复进行这些检查，同时进行改良Rankin量表、Barthel指数（BI）和医院焦虑抑郁量表（HADS）检查。在1个月时复查某些中风危险因素的存在情况。
共招募了75名患者。大多数患者到达医院及因此进行影像学检查存在延迟。只有4%的患者能在最初3小时内进行影像学检查。第5天的平均NIHSS评分为9分，第30天为6分。因此在1个月内显著降低。MMSE在第5天和第30天保持不变。较低的基线MMSE评分与1个月时NIHSS、BI和改良Rankin量表（mRS）的较差预后相关。1个月时的BI和mRS均表明约60%的病例预后较差。在48例非失语性MCA中风患者中，11例（22.92%）有抑郁。第5天NIHSS评分6分或以上预测1个月时预后较差。失语、优势叶受累和女性与1个月时较高的残疾相关。约30%的病例在1个月随访时有至少1项危险因素未得到控制。
我们的研究结果表明，在中风发作后第一周晚期使用NIHSS进行残疾评估可准确预测中风发作后1个月的预后。MMSE在1个月时预计也不会改变。有失语症的患者预计残疾程度更高。基于我们的研究，我们建议在出院前对中风患者进行NIHSS和MMSE评估，以解释患者的预后。此外，应常规进行更强化的关于控制血压和糖尿病以及戒烟的咨询。
