The Canadian Neurological Scale: a preliminary study in acute stroke.

599

432

Background and Purpose-The mechanisms for clinical deterioration in patients with ischemic stroke are not completely understood. Several proinflammatory cytokines are released early after the onset of brain ischemia, but it is unknown whether inflammation predisposes to neurological deterioration. We assessed the implication of interleukin (IL)-6 and tumor necrosis factor (TNF)-␣ in early neurological worsening in ischemic stroke. Methods-Two hundred thirty-one patients consecutively admitted with first-ever ischemic cerebral infarction within the first 24 hours from onset were included. Neurological worsening was defined when the Canadian Stroke Scale (CSS) score fell at least 1 point during the first 48 hours after admission. IL-6 and TNF-␣ were determined in plasma and cerebrospinal fluid (CSF; nϭ81) obtained on admission. Results-Eighty-three patients (35.9%) deteriorated within the first 48 hours. IL-6 in plasma (Ͼ21.5 pg/mL; OR 37.7, CI 11.9 to 118.8) or in CSF (Ͼ6.3 pg/mL; OR 13.1, CI 2.2 to 77.3) were independent factors for early clinical worsening, with multiple logistic regression. The association was statistically significant in all ischemic stroke subtypes as well as in subjects with cortical or subcortical infarctions. IL-6 in plasma was highly correlated with body temperature, glucose, fibrinogen, and infarct volume. CSF and plasma concentrations of TNF-␣ were also higher in patients who deteriorated, but the differences observed did not remain significant on multivariate analysis. Conclusions-In addition to participating in the acute-phase response that follows focal cerebral ischemia, IL-6 levels on admission are associated with early clinical deterioration. The association between IL-6 and early neurological worsening prevails without regard to the initial size, topography, or mechanism of the ischemic infarction. (Stroke.

Section: Methodsmentioning

confidence: 99%

Proinflammatory Cytokines and Early Neurological Worsening in Ischemic Stroke

Vila¹,

Castillo²,

Dávalos³

et al. 2000

599

432

“…19 However, the NIHSS has been criticized for its complexity and the underweighting for posterior circulation strokes, a shared problem by all stroke scales. 20 A few prognostic scores implement the Canadian Neurological Scale (CNS), 21 which has shown good inter-rater reliability 22 and can be converted to the NIHSS score with the use of a validated conversion mathematical formula. 23 None of the scores used Scandinavian Stroke Scale.…”

Section: Pathophysiologic Insights Into Scores' Constituents and Stromentioning

confidence: 99%

Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

Ntaios

Papavasileiou

Michel

et al. 2015

“…26 The following data were recorded: sociodemographic variables, neurological deficit at admission and hospital discharge in accordance with the Canadian Stroke Scale, 27 functional state at discharge by the Barthel Index 28 and the modified Rankin Scale, 29 length of hospital stay, data relating to the disease including classical vascular risk factors, neuroimaging characteristics, and the final etiopathogenic diagnosis of stroke, and the Trial of ORG 10172 in Acute Stroke Treatment classification for determination of the subtype of ischemic stroke. 30 A diagnosis of hemorrhagic stroke was considered if the clinical signs were compatible with stroke and an intracerebral hemorrhage was found at CT scan and/or MRI.…”

Section: Variables Studied During Hospitalizationmentioning

confidence: 99%

Smoking Cessation 1 Year Poststroke and Damage to the Insular Cortex

Soler

Grau²,

Gras³

et al. 2012

Background and Purpose-Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke. Methods-We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007. Results-On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95-15.01; Pϭ0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89 -28.07; Pϭ0.004). Conclusions-Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop. (Stroke. 2012;43:131-136.)