Comparison of the Clinical Course of Ischemic Stroke Depending on the Stroke Subtypes

Song, Young Mok; Lee, Chang Min; Lee, Geun Ho; Kim, Jae Il

Abstract

BACKGROUND: There is still scarce information on the clinical course and prognosis in acute stroke patients with different etiologies.
METHODS
We studied 464 patients with acute ischemic stroke within 24 hours of onset. Patients were assigned to 5 stroke subtypes based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria with slight modification: small vessel occlusion (SVO, 30%), large artery atherosclerosis (LAA, 29%), cardioembolism (CE, 23%), stroke of two or more etiologies (STM, 12%), and stroke of undetermined etiology (SUD, 7%). The NIH Stroke Scale was used to assess the neurological status at day 0, 1, 3, 7, 14, and 28 after admission. The neurological deterioration and improvement at the examination period and the extent of recovery at one month were evaluated in different stroke subtypes.
RESULTS
Most of the neurological deterioration occurred within 7 days after stroke, most frequently in LAA (30%), followed by STM (24%) and SVO (17%), and least frequently in CE (13%) and SUD (10%). In contrast, the temporal profile of neurological improvement was not different between subtypes. Patients with good recovery were most common in SVO (64%), whereas those with no recovery were most common in LAA (22%) and STM (28%).
CONCLUSIONS
The clinical course was different according to stroke etiologies. Patients with LAA and STM experienced more frequent neurological deterioration and poorer recovery. SVO was associated with milder stroke and better recovery. CE and SUD caused severe neurological deficit, but lead to less frequent neurological deterioration and favorable recovery.