PURPOSE: Although early neurological deterioration (END) during the acute stroke period is known to be associated with poor functional outcomes, there is little data regarding the impact of END on long-term outcomes according to the characteristics of END. The aim of this study was to investigate whether there are differences in long-term mortality according to the characteristics of END among acute ischemic stroke or transient ischemic attack patients. MATERIALS AND METHODS: END was defined as any increase (> or =1) in National Institute of Health Stroke Scale score within 7 days after admission. We assessed the characteristics of END, such as the etiology and severity of END, as well as recovery after END. The relationship between 30-day or long-term mortality and each characteristic of END was investigated using multiple logistic analysis or Cox regression model. RESULTS: Among 2820 patients, END was observed in 344 patients (12.2%). After adjustment for age, sex, underlying cardiovascular diseases, stroke severity, and stroke subtypes, END was associated with long-term mortality, whether it was mild or severe and whether or not it was followed by recovery. However, 30-day mortality was strongly related to the severity of END or the absence of recovery after END. Among the causes of END, recurrent stroke and medical illness were related to 30-day mortality, as well as long-term mortality, while brain herniation and intracranial hemorrhagic complications were only associated with 30-day mortality. CONCLUSION: The results of the present study demonstrated that END is associated with higher mortality and the effects of END on short-term and long-term mortality depend on END characteristics.
Aged ; Brain Ischemia/mortality/*physiopathology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stroke/mortality/*physiopathology

OBJECTIVETo examine electroencephalographic (EEG) background patterns and serum neuron specific enolase (NSE) levels in neonates with hypoxic-ischemic encephalopathy (HIE) in order to study their roles in assessing clinical progress, severity and prognosis in children with HIE.

METHODSA total of 58 neonates with HIE, including 38 cases of mild, 12 cases of moderate and 8 cases of severe HIE, were enrolled. Thirty normal neonates were used as the control group. Serum NES levels were measured by radioimmunoassay 12-24 hrs and 7-10 days after birth. EEG examination was performed 24 hrs-18 days of age (early stage) and 28-30 days of age (convalescence stage). The neonates with HIE were followed-up, with a duration of 6 months to 3 years.

RESULTSFifty-five neonates with HIE (94.8%) showed EEG abnormalities in the early stage, but only 2 patients (6.7%) in the control group (p<0.01). EEG background patterns abnormalities in the early stage were found in 90.0% (18/20) of moderate-severe HIE neonates. The proportion was significantly higher than that in the mild HIE group [5.2% (2/38); p<0.01]. Thirteen (72.2%) out of 18 patients with early EEG background patterns abnormalities had poor outcomes. Serum levels of NES in the HIE group were significantly higher than those in the control group 12-24 hrs after birth (p<0.01). EEG background patterns abnormalities and increased serum levels of NES 12-24 hrs after birth were consistent with the clinical grading of HIE. Most of neonates [87.5% (7/8)] who showed abnormal EEG background patterns at the convalescence stage had neurological sequelae.

CONCLUSIONSEEG background patterns and serum NSE levels may be useful in assessment of disease severity and neurological outcome in children with HIE.

Electroencephalography ; Female ; Humans ; Hypoxia-Ischemia, Brain ; blood ; mortality ; physiopathology ; Infant, Newborn ; Male ; Phosphopyruvate Hydratase ; blood ; Prognosis