Progressive ischemic stroke in the symptomatic subgroups of the Oxfordshire Community Stroke Project.
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We investigated the frequency, possible predictive factors and prognosis of progressive ischemic stroke in four clinical subgroups according to the classification of the Oxfordshire Community Stroke Project (OCSP). In total, 250 consecutive patients with first ever ischemic stroke within 24 hours of onest were enrolled. Based on the OCSP criteria, the patients were divided into four clinical subgroups, viz., total anterior circulation infarcts (TACT), partial anterior circulation infarcts (PACT), lacunar infarcts (LACI), and posterior circulation infarcts (POCI). Clinical progression was defined as a decrease of 1 or more points in the Canadian Neurological Scale (CNS)or Rankin Disability Scale (RDS). In each clinical subgroup, progressive (P) and non-progressive (N) patients were compared in terms of their clinical background, risk factors, vital signs, blood and chemical data and cranial CT at the time of hospitalization. The acute-stage mortality and functional outcome were also compared. The subjects comprised 57 (23%) patients with TACI, 47 (19%) with PACT, 104 (42%) with LACI, and 42 (17%) with POCI. The progression rate was significantly lower in the PACT group (9%) as compared to the other three groups (p<0.01; 37% in TACT, 31% in LACI, and 29% in POCI). There were a few clinical variables which differed significantly between the P and N groups. In the P group of TACT patients, the serum cholesterol was lower and early abnormalities of the cranial CT (early infarction, early parenchymatous signs or hyperdense middle cerebral artery signs) were more frequent than in the N group of TACT. In the P group of LACI, the CNS score was lower than in the N group of LACI. However, there were no other differences between the P and N groups of TACT and LACI, and none of the clinical variables differed between the two groups of POCI. P versus N comparisons were not performed for the PACT group because the number of P was too small. The mortality of the P group of patients with TACT and POCI exceeded 40%, and the functional outcome was worse in TACT, LACI, and POCI group patients than in each corresponding N group. In conclusion, it can be said that the progression rate in acute ischemic stroke differed among the OCSP subgroups, and progression significantly worsened the prognosis. Despite the identification of a few factors which could predict deterioration, exact prediction of the progression remained unattainable. Further research to find sophisticated radiological and chemical markers appears to be needed.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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