Deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project

Background and Purpose-The aim of this study was to investigate the frequen cy, possible predictive factors, and prognosis of deteriorating ischemic st roke in 4 clinical categories according to the classification of the Oxford shire Community Stroke Project (OCSP). Methods-A total of 350 patients with first-ever ischemic stroke who present ed within 24 hours of onset were enrolled. Based on the OCSP criteria, cere bral infarctions were divided into the following 4 clinical categories: tot al anterior circulation infarcts (TACI), partial anterior circulation infar cts (PACI), lacunar infarcts (LACI), and posterior circulation infarcts (PO CI). Clinical deterioration was defined as a decrease of greater than or eq ual to 1 points in the Canadian Neurological Scale (CNS) (in TACI, PACI, an d LACI) or Rankin Scale (RS) (in POCI) during 7 days from the onset. In eac h clinical category, deteriorating (D) and nondeteriorating (ND) patients w ere compared in terms of their background characteristics, risk factors, vi tal signs, laboratory data, and cranial CT at the time of hospitalization. The acute-phase mortality and functional outcome were also compared. Results-The subjects comprised 86 patients (24.6%) with TACI, 63 (18.0%) wi th PACI, 141 (40.3%) with LACI; and 60 (17.1%) with POCI. Overall, 90 patie nts (25.7%) deteriorated. The frequency was very high in TACI (41.9%), foll owed by LACI (26.2%) and POCI (21.7%), whereas it was very low in PACI (6.3 %). There were some clinical variables that differed significantly between D and ND groups. In the patients with TACI, early abnormalities of the cran ial CT and significant stenoses in corresponding arteries were more frequen t in the D than the ND group. In those with LACI, the CNS and hematocrit we re lower in the D than the ND group. In those with POCI, cerebral atrophy w as more severe and significant stenoses in vertebrobasilar arteries were mo re frequent in the D than ND group. The mortality of the D groups of patien ts with TACI and POCI exceeded 35%, and the functional outcome was worse in the D group than in the ND group of patients with TACI, LACI, and POCI. Conclusions-The frequency of deterioration in acute ischemic stroke signifi cantly differed among the OCSP subgroups, and deterioration worsened the pr ognosis. There were some factors that could predict deterioration: early CT findings in TACI, large-artery atherosclerosis in TACI and POCI, and strok e severity in LACI, Further research to find sophisticated radiological and chemical markers appears to be needed.