Predisposing factors for acute deterioration of minor ischemic stroke

J Neurol Sci. 2009 Dec 15;287(1-2):147-50. doi: 10.1016/j.jns.2009.08.006. Epub 2009 Sep 8.


Purpose: Since attention should be paid to acute stroke patients who may easily worsen, we investigated the predisposing factors for acute deterioration of minor ischemic stroke in Japanese patients.

Methods: We retrospectively investigated 543 patients who were admitted within 7 days of the occurrence of an acute minor stroke with National Institute of Health Stroke Scale (NIHSS) score of 4 or less, between January 2002 and September 2005. Deterioration of neurological findings was defined as the worsening by 2 points or more of the NIHSS score during admission to the hospital.

Results: Out of 543 patients, deterioration was noted in 37 patients (6.8%: deterioration group), and not in the other 506 patients (93.2%: non-deterioration group). Multivariate analysis demonstrated that the factors associated with worsening were atherothrombotic brain infarction (deterioration group vs. non-deterioration group: 35.1% vs. 18.0%, P=0.049), elevated systolic blood pressure (170.5+/-32.4 mm Hg vs. 160.4+/-27.4 mm Hg, P=0.033), serum glucose level on admission (146.1+/-60.5mg/dL vs. 121.7+/-54.9 mg/dL, P=0.048), and presence of paralysis (73.0% vs. 54.9%, P=0.003) and vertigo (16.2% vs. 7.9%, P=0.034). The more factors there were that were associated with worsening (atherothrombotic infarction; systolic blood pressure >140 mm Hg; serum glucose level >140 mg/dL; and paralysis, vertigo, and dizziness), the more frequently the deterioration occurred (number of worsening factors 0-2: 4.6%, 3: 12.8%, 4: 32.3%). Although over 80% of patients in the group without deterioration had good functional outcome at discharge, over 90% of patients with deterioration either were discharged to nursing home care or died.

Conclusion: In this study, the predisposing factors for acute deterioration in minor ischemic stroke were atherothrombotic brain infarction; high blood pressure; elevated serum glucose level; and paralysis, vertigo, and dizziness. Once patients with minor ischemic stroke deteriorated, their functional outcome at discharge was significantly worse than those who had not deteriorated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / epidemiology
  • Aged
  • Aged, 80 and over
  • Blood Glucose / physiology
  • Blood Pressure / physiology
  • Causality
  • Comorbidity
  • Disease Progression
  • Dizziness / epidemiology
  • Dizziness / physiopathology
  • Female
  • Humans
  • Hyperglycemia / epidemiology*
  • Hyperglycemia / physiopathology
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Intracranial Arteriosclerosis / epidemiology*
  • Intracranial Arteriosclerosis / physiopathology
  • Male
  • Middle Aged
  • Paralysis / epidemiology
  • Paralysis / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Recovery of Function / physiology
  • Retrospective Studies
  • Stroke / epidemiology*
  • Stroke / physiopathology
  • Vertigo / epidemiology
  • Vertigo / physiopathology


  • Blood Glucose