Progressive ischemic cerebrovascular stroke: frequency and predictive factors

ABSTRACT

To determine the frequency of progression in patients with ischemic stroke and to identify clinical, laboratory and radiological factors that could lead its to early prediction. Two hundred patients with ischemic stroke presented within 24 hours from onset of symptoms were included in the study. They were 121 males and 79 females with mean age [60.5 +/- 11.2] years. The following predictors were assessed clinical predictors age, sex, TIA, cardiac disease, diabetes mellitus, hypertension, cigarette smoking, time to admission, Glasgow coma scale, systolic and diastolic blood pressure and body temperature. Laboratory predictors random and fasting blood sugar, prothrombin time, partial thromboplastin time, liver enzymes, serum creatinine, erythrocyte sedimentation rate, serum cholesterol, high and low density lipoprotein, C-reactive protein and serum ferritin. Radiological predictors early focal hypodensity and initial mass effect in admission CT brain scan and site and size of infarction, mass effect and hemorrhagic infarction in follow up CT scan [7days]. Neurological deficits were assessed by Scandinavian Stroke Scale on admission, 24 hours and 7 days after admission to diagnose progressive stroke. Early progressive stroke was considered when progression occurred within 24 hours after admission. Late progressive stroke was considered when progression occurred between 24 hours and 7 days. The frequency of progressive stroke was 20% [13% early progression and 7% late progression]. History of hypertension, high systolic and diastolic blood pressure, low Glasgow coma scale, short time to admission, elevated serum glucose, cholesterol, C-reactive protein and ferritin, early focal hypodensity in the initial CT and cortico-subcortical and medium size infarction in follow up CT were significantly frequent in patients with progressive stroke. Admission hyperglycemia and high ferritin level were significantly frequent in early progressive stroke patients, while high serum C-reactive protein and cholesterol levels and were significantly frequent in late progressive stroke patients