Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

Association of stroke severity, leukocytosis, and infarction size with early neurological deterioration in acute ischemic stroke

The Egyptian Journal of Internal Medicine volume 31, pages 774–778 (2019)Cite this article

Abstract

Background

About one-third of patients with acute ischemic stroke will endure early neurological deterioration (END), which leads to increased mortality and functional disability. A better understanding of risk factors for END is still required.

Objective

The aim of this study was to determine the risk factors of END in ischemic stroke patients.

Patients and methods

One hundred and twenty patients with first ever ischemic stroke were included in this study. All patients were clinically evaluated to determine the risk factors. END was assessed using the National Institute of Health Stroke Scale (NIHSS) after acute ischemic stroke. Laboratory and radiological investigations were done for all patients.

Results

In all, 35% patients showed clinical END after stroke onset and 65% patients were stable or improved. END patients had statistically significant high body temperature, increased leukocyte count, serum blood glucose, triglycerides, NIHSS at admission, high-sensitivity C-reactive protein, and infarction size. Multivariable logistic regression analysis for different variables showed that leukocyte count, stroke severity using NIHSS, and lesion size were independent factors associated with neurological deterioration.

Conclusion

Stroke severity, white blood cell, and lesion size of infarction were the only independent factors associated with END.

References

  1. Siegler JE, Martin-Schild S. Early neurological deterioration (END) after stroke: the END depends on the definition. Int J Stroke 2011; 6:211–212.

    Article  Google Scholar 

  2. Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S, et al. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke J Cerebral Circ 2008; 39:355–360.

    Article  Google Scholar 

  3. Jin R, Yang G, Li G. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. J Leukoc Biol 2010; 87:779–789.

    Article  CAS  Google Scholar 

  4. Smith CJ, Emsley HC, Gavin CM, Georgiou RF, Vail A, Barberan EM, et al. Peak plasma interleukin-6 and other peripheral markers of inflammation in the first week of ischaemic stroke correlate with brain infarct volume, stroke severity and long-term outcome. BMC Neurol 2004; 4:2–5.

    Article  Google Scholar 

  5. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Beasley M, Martin-Schild S. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 5:1–7.

    Google Scholar 

  6. Saini M, Saqqur M, Kamruzzaman A, Lees KR, Shuaib A. Effect of hyperthermia on prognosis after acute ischemic stroke. Stroke 2009; 40:3051–3059.

    Article  Google Scholar 

  7. Nardi K, Milia P, Eusebi P, Paciaroni M, Caso V, Agnelli G. Admission leukocytosis in acute cerebral ischemia: influenceon early outcome. J Stroke Cerebrovasc Dis 2012; 21:819–824.

    Article  Google Scholar 

  8. Mu S, Ouyang L, Liu B. Relationship between inflammatory reaction and ischemic injury of caudate putamen in rats: inflammatory reaction and brain ischemia. Anat Sci Int 2011; 86:86–97.

    Article  CAS  Google Scholar 

  9. Youn CS, Choi SP, Kim SH, Oh SH, Jeong WJ, Kim HJ, et al. Serum highly selective C-reactive protein concentration is associated with the volume of ischemic tissue in acute ischemic stroke. Am J Emerg Med 2012; 30:124–128.

    Article  Google Scholar 

  10. Seo WK, Seok HY, Kim JH, Yu SW, Oh K, Koh SB, Park KW. C-reactive protein is a predictor of early neurologic deterioration in acute ischemic stroke. J Stroke Cerebrovasc Dis 2012; 21:181–186.

    Article  Google Scholar 

  11. Kvistad CE, Thomassen L, Waje-Andreassen U, Naess H. Low body temperature associated with severe ischemic stroke within 6h of onset: The Bergen NORSTROKE Study Vascular Health and Risk Management. Stroke 2012; 8:333–338.

    Google Scholar 

  12. Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 2006; 99:625–633.

    Article  CAS  Google Scholar 

  13. Kiers L, Davis SM, Larkins R, Hopper J, Tress B, Rossiter SC. Stroke topography and outcome in relation to hyperglycaemia and diabetes. J Neurol Neurosurg Psychiatry 1992; 55:263–270.

    Article  CAS  Google Scholar 

  14. Miyamoto N, Tanaka Y, Ueno Y, Kawamura M, Shimada Y, Tanaka R, et al. Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 22:205–210.

    Article  Google Scholar 

  15. Röden-Jüllig Å, Britton M, Malmkvist K. Aspirin in the prevention of progressing of stroke: a randomized controlled study. J Intern Med 2003; 254:584–590.

    Article  Google Scholar 

  16. AboEl-Naga Y. Predictors of early progression in ischemic stroke. Eur J Neurol 2007; 44:207–223.

    Google Scholar 

  17. Ong CT, Wu CS. Neurological deterioration in patients with first-ever ischemic stroke. Acta Neurol Taiwan 2007; 16:143–149.

    PubMed  Google Scholar 

  18. Kumar AD, Boehme AK, Siegler JE, Gillette M, Albright KC, Martin-Schild S. Leukocytosis in patients with neurologic deterioration after acute ischemic stroke is associated with poor outcomes. J Stroke Cerebrovasc Dis 2012; 22:1–7.

    Google Scholar 

  19. Lin LC, Hsiao KY, Tsai YH, Lai SL, Lei CC, Hsiao CT. Predictors of clinical deterioration during hospitalization following acute ischemic stroke. Eur Neurol 2012; 67:186–192.

    Article  Google Scholar 

  20. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352:1685–1695.

    Article  CAS  Google Scholar 

  21. Tanaka R, Ueno Y, Miyamoto N, Yamashiro K, Tanaka Y, Shimura H, et al. Impact of diabetes and prediabetes on the short-term prognosis in patients with acute ischemic stroke. J Neurol Sci 2013; 332:45–50.

    Article  CAS  Google Scholar 

  22. Leira R, Rodríguez-Yáñez M, Castellanos M, Blanco M, Nombela F, Sobrino T, et al. Hyperthermia is a surrogate marker of inflammation-mediated cause of brain damage in acute ischaemic stroke. J Intern Med 2006; 260:343–349.

    Article  CAS  Google Scholar 

  23. Boysen G, Christensen H. Stroke severity determines body temperature in acute stroke. Stroke 2001; 32:413–417.

    Article  CAS  Google Scholar 

  24. Karaszewski B, Wardlaw JM, Marshall I, Cvoro V, Wartolowska K, Haga K, et al. Measurement of brain temperature with magnetic resonance spectroscopy in acute ischemic stroke. Ann Neurol 2006; 60:438–446.

    Article  Google Scholar 

  25. Akopov SE, Simonian NA, Grigorian GS. Dynamics of polymorphonuclear leukocyte accumulation in acute cerebral infarction and their correlation with brain tissue damage. Stroke 1996; 27:1739–1743.

    Article  CAS  Google Scholar 

  26. Di Napoli M. Early inflammatory response in ischemic stroke. Thromb Res 2001; 103:261–264.

    Article  Google Scholar 

  27. Toyoda K, Fujimoto S, Kamouchi M, Iida M, Okada Y. Acute blood pressure levels and neurological deterioration in different subtypes of ischemic stroke. Stroke 2009; 40:2585–2588.

    Article  Google Scholar 

  28. Abubakar SA, Okubadejo NU, Ojo OO, Oladipo O, Ojini FI, Danesi MA. Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria. Niger J Clin Pract 2013; 16:320–324.

    Article  CAS  Google Scholar 

  29. Luo Y, Wang Z, Li J, Xu Y. Serum CRP concentrations and severity of ischemic stroke subtypes. Can J Neurol Sci 2012; 39:69–73.

    Article  Google Scholar 

  30. Dohmen C, Galldiks N, Bosche B, Kracht L, Graf R. The severity of ischemia determines and predicts malignant brain edema in patients with large middle cerebral artery infarction. Cerebrovasc Dis 2012; 33:1–7.

    Article  Google Scholar 

  31. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the national institutes of health stroke scale should define neurologic deterioration in acute ischemic stroke? J Stroke Cerebrovasc Dis 2012; 22:675–682.

    Article  Google Scholar 

  32. Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 2009; 8:724–730.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Zagazig University, Zagazig, 44519, Egypt

    Jehan Saeed & Ghada M. Samir

  2. Department of Department of Public Health and Community Medicine, Zagazig University, Zagazig, Egypt

    Ahmed F. El-Said

Authors
  1. Jehan Saeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ghada M. Samir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed F. El-Said
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jehan Saeed.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saeed, J., Samir, G.M. & El-Said, A.F. Association of stroke severity, leukocytosis, and infarction size with early neurological deterioration in acute ischemic stroke. Egypt J Intern Med 31, 774–778 (2019). https://doi.org/10.4103/ejim.ejim_122_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_122_18

Keywords