Neurological improvement following strokes may still lead to unfavorable outcomes

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Although nearly one-fifth of adults with acute stroke syndromes had rapid neurological improvement before entering the hospital, 47 percent of that group was not discharged to their homes, according to a post-hoc analysis of a randomized trial.

Lead researcher Clotilde Balucani, MD, PhD, a research assistant professor in neurology at the State University of New York Downstate Medical Center in Brooklyn, presented the results at the American Stroke Association’s International Stroke Conference on Feb. 17.

“Patients with very early rapid neurological improvement when first examined at the hospital still need to be considered for therapy to dissolve blood clots, given the high rate of unfavorable outcome,” Balucani said in a news release.

The researchers evaluated the randomized, double-blind, placebo controlled FAST-MAG (Field Administration of Stroke Therapy-Magnesium) study, which enrolled 1,700 adults with acute stroke syndromes.

They defined rapid neurological improvement as a decrease of two or more points in the Los Angeles Motor Scale from before the hospital until they entered the hospital. They considered dramatic rapid neurological improvement as a four or more point decline on the same scale.

Of the adults, 19 percent had rapid neurological improvement, 6 percent had dramatic rapid neurological improvement and 75 percent had no improvement. The mean age was 71.4 among adults with rapid neurological improvement, 67.1 among adults with dramatic rapid neurological improvement and 69.1 among adults with no improvement. Meanwhile, the median National Institutes of Health Stroke Scale score was 3, 0 and 12, respectively, among the groups.

In addition, 53 percent, 64 percent and 25 percent of adults, respectively, were discharged to their homes. Further, 61 percent of adults with rapid neurological improvement had an excellent outcome compared with 28 percent of adults with no improvement.

If adults weren’t discharged to their homes, the researchers said they may have been sent to nursing homes or rehabilitation centers, although the researchers did not reveal the percentages of each group. They plan on evaluating patients only with clot-caused stroke in a future study.

“To the extent that the data show a significant percent of patients with rapid neurological improvement do not have a good outcome, clinicians should strongly consider giving these patients intravenous medication to dissolve blood clots,” Balucani said.