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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Aphasia predicts unfavorable outcome in mild ischemic stroke patients and prompts thrombolytic treatment
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Aphasia predicts unfavorable outcome in mild ischemic stroke patients and prompts thrombolytic treatment

机译：失语症预示着轻度缺血性中风患者的不良预后并提示溶栓治疗

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Background: Patients with an acute ischemic stroke rated as mild, and for this reason not submitted to thrombolysis, have an unfavorable outcome in a non-negligible proportion. Whether selective presentation features help identify those at risk of bad outcome, and whether it could be recommended to treat only patients with such features, is poorly elucidated. We report our experience based on retrospective evaluation of a consecutive series of patients scoring 6 or less on baseline National Institutes of Health Stroke Scale (NIHSS), some of whom received thrombolysis. Methods: From the prospective Careggi Hospital Stroke Registry, Florence, Italy, we selected a series of patients who fulfilled the following criteria: (1) screening for treatment within 3 hours of symptom onset; (2) mild symptoms, defined as a score of 6 or less on NIHSS, with or without rapid improvement; (3) no other reason for exclusion from thrombolysis; (4) no previous disability; and (5) admission to the stroke unit. We choose a modified Rankin scale score of less than 2 to define a good 3-month functional outcome. We studied as potential outcome predictors: age, baseline NIHSS score, isolated aphasia, motor impairment with or without aphasia, thrombolysis, previous stroke or transient ischemic attack, and interactions between each of these factors and thrombolysis. Results: Between February 2004 and June 2011, 128 patients fulfilled the selection criteria: 47 (36.7%) received tissue plasminogen activator, 81 (63.3%) did not. At 3 months, of the 81 patients not receiving tissue plasminogen activator, 14 (17.3%) had an unfavorable outcome, compared with 6 (12.8%) among the 47 treated. Hemorrhagic complications or death occurred in neither group. Adjusting for major confounders and for thrombolysis, the presence of aphasia on early assessment proved the only independent predictor of worse outcome. NIHSS score variation showed no effect. Conclusions: Aphasia is an early marker of unfavorable outcome in mild ischemic stroke patients. In these patients thrombolysis should be considered beyond the NIHSS scoring.
机译：背景：急性缺血性中风的患者被定为轻度患者，因此未接受溶栓治疗，其预后不良的比例不可忽略。选择性表现特征是否有助于识别那些有不良结果风险的人，以及是否建议仅治疗具有这种特征的患者，目前尚不清楚。我们根据对基线在国立卫生研究院卒中量表（NIHSS）上得分6或以下的连续系列患者的回顾性评估报告我们的经验，其中一些患者接受了溶栓治疗。方法：从意大利佛罗伦萨的前瞻性Careggi医院中风登记处，我们选择了一系列符合以下标准的患者：（1）在症状发作3小时内进行治疗筛查; （2）轻度症状，定义为NIHSS评分为6分或以下，有或没有快速改善; （3）没有其他理由被排除在溶栓治疗之外; （4）以前没有残疾; （5）进入卒中单元。我们选择小于2的改良兰金量表评分，以定义良好的3个月功能预后。我们研究了潜在的结局指标：年龄，基线NIHSS评分，孤立性失语，伴或不伴失语的运动障碍，溶栓，既往中风或短暂性脑缺血发作，以及这些因素与溶栓之间的相互作用。结果：在2004年2月至2011年6月之间，有128例患者符合选择标准：47例（36.7％）接受了组织纤溶酶原激活剂，81例（63.3％）没有接受。在3个月时，未接受组织纤溶酶原激活剂的81位患者中，有14位（17.3％）的转归不良，而接受治疗的47位患者中有6位（12.8％）。两组均未发生出血并发症或死亡。调整主要混杂因素和溶栓后，早期评估中失语症的存在被证明是恶化预后的唯一独立预测因子。 NIHSS分数变化未显示效果。结论：失语是轻度缺血性中风患者不良预后的早期标志。在这些患者中，应考虑血栓溶解超过NIHSS评分。

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