The Importance of Brain Infarct Size and Location in Predicting Outcome after Stroke

Beloosesky, Yichayaou; Streifler, Jonathan Y.; Burstin, Arie; Grinblat, Joseph

doi:10.1093/ageing/24.6.515

Cited by 51 publications

(43 citation statements)

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“…There was however no age bias for CT scans and the main reason for not performing a CT scan was the poor general condition of the patient where it was considered inappropriate to transport the patient to the CT scan department. Although there is no agreed method of classifying cerebral infarct size on CT scan, the method we have adopted is in agreement with other authors [14, 15]. …”

Section: Discussionsupporting

confidence: 85%

“…Patients with severe stroke syndromes as defined on the Oxfordshire Community Stroke Project (OCSP) [13], larger cerebral infarcts on computerised tomography (CT) scans [14, 15]development of pyrexia [16, 17]and presence of dysphagia [18, 19]have a higher mortality and disability.…”

Section: Introductionmentioning

confidence: 99%

“…Is it that the older patients have more frequent severe pathology on CT scan, i.e., haemorrhages or larger infarcts [14, 15]or more frequent severe stroke syndromes known to be associated with poor outcome, i.e., total anterior circulation syndromes as defined by the Oxfordshire Community Stroke Project (OCSP) classification [13], or is the higher mortality in the older stroke patients secondary to age-related factors, i.e., poor global health not related to acute stroke? This study attempts to answer these questions.…”

Section: Introductionmentioning

confidence: 99%

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Strokes in the Elderly – Higher Acute and 3-Month Mortality – An Explanation

Sharma

Fletcher

Vassallo³

1999

Cerebrovasc Dis

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Aim: Stroke is common in older people. The objective of the study was to determine if older stroke patients have a higher mortality and disability compared with younger patients for comparable stroke severity and pathology and whether there is an explanation for the difference. Methods: A prospective study was undertaken in 296 consecutive patients admitted with acute stroke. Patients were studied for neurological features, pre-stroke functional disability, severity of stroke defined by stroke syndromes and pathology of stroke on CT scans (202 patients). Post-stroke disability was defined according to the functional status within 72 h of admission. A record was made of the intercurrent illness while the patients were in acute wards and of the risk factors. Patients were dichotomised into two age groups: younger group – up to 75 years (163 patients) and older group – over 75 years (133 patients). Outcome was measured according to (1) discharge status from acute wards, i.e., dead or alive, and (2) mortality at 3 months. Results: Although there was no significant difference in severe clinical stroke syndromes (p = 0.72), CT scan features (p = 0.68) and pyrexia (0.38) between the two age groups, the older patients had significantly more disabling strokes as defined on Barthel Index (p = 0.015) and a higher mortality in the acute phase (p < 0.01) and at 3 months (p = 0.001). The older stroke patients had more severe pre-stroke disability (p < 0.001) and more severe neurological impairment for similar stroke severity and pathology. Early mortality was more influenced by pre-stroke global health than age whereas 3-month mortality was influenced by age to the exclusion of all other known prognostic factors. Conclusion: The older stroke patients have more disabling stroke and an increased mortality for a similar spectrum of stroke severity and pathology. The explanation for higher mortality of the older patients is the poor pre-stroke health and higher immediate post-stroke disability.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strokes in the Elderly – Higher Acute and 3-Month Mortality – An Explanation

Sharma

Fletcher

Vassallo³

1999

Cerebrovasc Dis

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“…White matter lesions indicated by PVH can reduce motor function and, consequently, influence FIM motor score at discharge. To summarize, it seems that in conjunction with stenosis or trunk artery occlusion, degree of white matter lesions may influence the presence of aphasia and spatial neglect, foci size, and lesion site, 30,31 as well as ADLs prognosis after convalescent rehabilitation. Therefore, assessment using intracranial MRI/MRA is necessary in convalescent rehabilitation patients.…”

Section: Discussionmentioning

confidence: 99%

Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke

Senda

Ito

Kotake

et al. 2016

Stroke

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4are widely used as classifications of ischemic stroke subtype. Although the pathologies of these subtypes are described by these criteria, no diagnostic methods or standards exist for neuroimaging and other examinations. The current diagnostic standards for ischemic stroke subtype used in clinical trials are from the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications.5 According to the TOAST classification system, artery-to-artery embolism (A-to-A) can be distinguished from atherothrombosis, 6 and both can be distinguished from CE. However, these concepts are not well Background and Purpose-We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Methods-Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Results-Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional IndependenceMeasure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (P<0.001), whereas in patients with artery-to-artery embolism or cardiogenic embolism and deep white matter hyperintensity grades were associated with Functional Independence Measure cognitive scores (P<0.05). Conclusions-Our study revealed that the degree of leukoaraiosis was associated with inpatient convalescent rehabilitation outcome in patients with ischemic stroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype.

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“…First, we were unable to assess important physiological and clinical characteristics such as lesion location and size, known to be important predictors of outcome. 4,5,36 Nonetheless, to some extent these features are captured within the TACS classification. Second, the study only included patients presenting to participating hospitals who consented to the study.…”

Section: Wei Et Almentioning

confidence: 99%

Comparison of Recovery Patterns and Prognostic Indicators for Ischemic and Hemorrhagic Stroke in China

Wei

Heeley

Wang

et al. 2010

Stroke

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Background and Purpose-Limited data exist on the comparative recovery patterns and outcomes of patients with ischemic stroke and intracerebral hemorrhage in China. Methods-Data on baseline characteristics and outcomes of 6354 patients at 3 and 12 months poststroke are fromChinaQUEST (QUality Evaluation of Stroke Care and Treatment), a multicenter, prospective, 62-hospital registry study in China. Logistic regression was used to determine factors associated with a poor outcome defined by death/ dependency (modified Rankin Scale score of 3 to 5) on follow-up. Generalized estimating equations were used to assess variations in recovery pattern by stroke type. Results-Baseline severity and rate of functional recovery in the early phase were significantly greater for intracerebral hemorrhage. However, patients with ischemic stroke were on average twice as likely to experience a good outcome (modified Rankin Scale score Ͻ3) by 12 months poststroke (OR: 1.98, CI: 1.76 to 2.24). In patients with ischemic stroke, diabetes and atrial fibrillation were strongly associated with a poor outcome at 12 months poststroke even after adjustment for confounding factors such as age, prior stroke/dependency, time to presentation, and stroke severity, whereas use of antiplatelets and lipid-lowering therapy after stroke were associated with improved outcome. For patients with intracerebral hemorrhage, low education and atrial fibrillation were associated with a poor outcome after adjustment for potential confounders and antihypertensive use was strongly associated with improved outcome. Conclusions-Patients with intracerebral hemorrhage and ischemic stroke have different recovery patterns in China.However, they share similar prognostic factors and in the use of evidence-based secondary prevention therapies to maximize chances of a good outcome. (Stroke.

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The Importance of Brain Infarct Size and Location in Predicting Outcome after Stroke

Cited by 51 publications

References 0 publications

Strokes in the Elderly – Higher Acute and 3-Month Mortality – An Explanation

Strokes in the Elderly – Higher Acute and 3-Month Mortality – An Explanation

Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke

Comparison of Recovery Patterns and Prognostic Indicators for Ischemic and Hemorrhagic Stroke in China

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