DOI: 0.36347/sjams.2020.v08i01.035

Pages: 178-190

Context: Progression of stroke is likely multifactorial; however, risk of deterioration in acute ischemic stroke can be predicted in great majority of cases at admission by careful close observation. Aims: To study the causes of neurological deterioration of non-thrombolysed stroke patients. Settings and Design: This was a prospective observational study of non-thrombolysed stroke patients admitted at the Stroke ICU of a teaching hospital in Kerala, India for a period of one year from between January 2017 to January 2018. Methods and Material: All stroke patients with first episode of acute ischemic stroke were admitted and evaluated forneurologic deterioration (defined as an increase in National Institute of Health Stroke Scale Score (NIHSS score) by 2 or more points, after admission during the first week). Results: 80 out of 320 patients with acute stroke patients developed neurological deterioration and were analyzed for clinical, biochemical and radiological features associated with deterioration. Clinical features - Stroke severity (high NIHSS Score), altered consciousness at admission, persistent gaze deviation, bulbar dysfunction, atrial fibrillation, recent myocardial infarction, systemic diseases (hypertension, hepatic and renal dysfunction) and deep vein thrombosis were associated with deterioration. Biochemical features - Uncontrolled blood sugar and hyponatremia were associated with deterioration. Imaging features - ASPECT score less than 7, large infarct at admission, dense MCA sign, hemorrhagic transformation, proximal large vessel occlusion and lack of correlation between clinical deficits with initial CT picture were associated with higher risk of deterioration. Conclusion: Each stroke case needs prompt individualized evaluation and management. Interventions based on pathophysiology identified by imaging features and patient’s clinical condition and management of systemic diseases and complications will improve the outcome.