Reasons of Neurological Deterioration in lschemic Stroke Subtypes

Abstract

Background: Some patients with stroke clinical deterioration because of many reasons since they admitted in hospital. Main reasons of this condition are re!ated to stroke progression raised cerebral edema, infection metabolic and cardiopulmonar disorders. Objective: İn this study reasons of neurological deterioration in patients with ischemic stroke, frequency of these reasons in different subtypes of stroke, relationship between these reasons and etiology, risk factors of stroke are investigated. Material and Methods: 268 patients with ischemic stroke, admitted to our clinic were reqruited to study. Patients were divided into two groups who were presented with clinical deterioration: 1- related to progression of stroke 2- related to raised cerebral edema. The patients, showed two points decrease according to Scandinavian Stroke Scale were assumed as stroke progression. The second group included the patients with clinical and radiological findings of cerebral herniation. Stroke subtypes of patients were investigated accordingto Oxfordshire Communuty Classification and etiology of stroke were evaluated according to Bamford criteria. Univariate analyses were used to neurological deterioration that were associated with risk factors, etiology and stoke subtypes. Findings: lncreased motor deficits was estabilished in 44 (% 16) patients within the first five days. There was no significant difference between the ischemic stroke subtypes from the point of view and frequency of stroke progression. However, large vessel diseases were much observed than cardioembolic strokes and small vessel diseases. There was no statistically significant difference for deterioration due to cerebral edema between the patient with large vessel disease and cardioembolic stroke but deterioration related to cerebral edemawas no observed in the patients with small vessel disease. Serum glucosis (146.7±65.6mg/dl, 131.5±51.5mg/dl p<0.05) and hematocrite (%41.1±6.6, %38.8±5.7 p<0.05) levels of patients with stroke progression were higher than others. İt was shown that deterioration due to cerebral edema appeared later than increasing of motor deficits due to stroke progression görüldü (mean 79.2±93.1 and 42±33.7 hour p< 0.001). Conclusion: İn patients with ischemic stroke, it is important to know the factors causing clinical deterioration for preventing mortality and morbidity.