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Objective: To determine the frequency of early neurologic deterioration with infarct expansion (ENDIE) and poor outcomes among ischemic stroke patients not treated with reperfusion therapies because of rapidly improving or mild symptoms (RIMS) and to study the predictive value of hyperacute MRI in these patients.
Methods: We identified consecutive patients with symptoms of acute stroke undergoing multimodal MRI within 6 hours of onset without evidence of hemorrhage on imaging. Medical records were reviewed for evidence of early neurologic deterioration within 48 hours. All deteriorating patients had repeat MRI to ascertain causes of worsening. Poor outcome was defined as a discharge modified Rankin Scale (mRS) score of ≥3.
Results: We identified 74 patients with stroke symptoms ≤6 hours from onset. Forty had RIMS, and 39 did not receive reperfusion therapies because of RIMS. Among these 39, 4 experienced ENDIE, and 8 were discharged with mRS score of ≥3. Eight of the 39 patients had large-vessel occlusions on MR angiography. Three of 8 patients with large-vessel occlusion as against only one of 31 patients without occlusion had ENDIE (odds ratio [OR] 18, 95% CI 1.6 to 209, p = 0.02). Four of 8 patients with large-vessel occlusion as against 4 of 31 patients without occlusion had a discharge mRS score of ≥3 (OR 7, 95% CI 1.2 to 38, p = 0.04).
Conclusions: About 10% of patients eligible for acute reperfusion therapy excluded on the basis of mild or rapidly improving symptoms show early neurologic deterioration with infarct expansion within 48 hours, and about 20% show poor outcome at discharge. Persisting large-vessel occlusion substantially increases the risk of early worsening and poor functional outcome.

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Published In

Volume 67Number 6September 26, 2006
Pages: 980-984
PubMed: 17000964

Publication History

Published online: September 25, 2006
Published in print: September 26, 2006


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Affiliations & Disclosures

V. Rajajee, MD
From the UCLA Medical Center, Los Angeles, CA.
C. Kidwell, MD
From the UCLA Medical Center, Los Angeles, CA.
S. Starkman, MD
From the UCLA Medical Center, Los Angeles, CA.
B. Ovbiagele, MD
From the UCLA Medical Center, Los Angeles, CA.
J. R. Alger, PhD
From the UCLA Medical Center, Los Angeles, CA.
P. Villablanca, MD
From the UCLA Medical Center, Los Angeles, CA.
F. Vinuela, MD
From the UCLA Medical Center, Los Angeles, CA.
G. Duckwiler, MD
From the UCLA Medical Center, Los Angeles, CA.
R. Jahan, MD
From the UCLA Medical Center, Los Angeles, CA.
A. Fredieu, MD
From the UCLA Medical Center, Los Angeles, CA.
S. Suzuki, MD
From the UCLA Medical Center, Los Angeles, CA.
J. L. Saver, MD
From the UCLA Medical Center, Los Angeles, CA.


Address correspondence and reprint requests to Dr. V. Rajajee, 28 Second Main Road, C.I.T Colony, Chennai 600004, India; e-mail: [email protected]

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