Medical and social aspects of predicting the course of ischemic stroke in the acute period

Abstract

Objective. To study the influence of medical and social characteristics of the patient on the possibility of predicting the course of ischemic stroke in the acute period. Materials and methods. A prospective cohort study was conducted involving 162 patients with ischemic stroke, hospitalized within the first 24 hours of symptom onset, were examined. The degree of neurological deficit and stroke severity were assessed using the NIHSS at 1- to 2-day intervals for 4 weeks during the acute period (up to 21 days) and the early recovery phase. Upon admission, 38 patients (23.4 %) had a mild stroke, 44 patients (27.2 %) had a moderate stroke, 36 patients (22.2 %) had a moderate to severe stroke, and 44 patients (27.2 %) had a severe stroke. Changes in stroke severity according to NIHSS were recorded as a percentage of the baseline values obtained upon admission. Results. When assessing the dynamics of changes in stroke severity using the NIHSS, four patterns of acute disease course were identified. In the first pattern, characterized by a rapid increase in symptoms during the first seven days, stroke severity increased significantly, while the patient’s condition remained stable over the next two weeks, with some improvement by the end of the acute period. In the second pattern a slow progression of stroke severity was noted. The third pattern was characterized by an intermittent course, with alternating periods of stabilization and deterioration. The fourth pattern was characterized by a moderate increase in clinical symptoms during the first two weeks, followed by their almost complete disappearance by the end of the acute period (day 21), corresponding to the concept of "minor stroke." Patients in the first three groups with specific patterns of acute ischemic stroke were analyzed for 12 risk factors. Based on the study results, a generalized medical and social patient profile was formulated for each identified pattern of acute ischemic stroke. Conclusions. During the study, a model for predicting the course of the acute period of ischemic stroke was developed, which demonstrates a reliability of over 80 % in the presence of three risk factors.