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BRIEF RESEARCH REPORT article

Front. Stroke
Sec. Acute Stroke and Interventional Therapies
Volume 4 - 2025 | doi: 10.3389/fstro.2025.1518685

Early Neurological Deterioration following acute stroke: association with reperfusion therapies and National Institute of Health Stroke Scale score

Provisionally accepted
Cameron Lee Cameron Lee 1*Tony Bing Yu Tony Bing Yu 1Mohammed Mallah Mohammed Mallah 1,2Caroline Belo Caroline Belo 1Maria Lucia Uribe Mz Recaman Maria Lucia Uribe Mz Recaman 1Yassine Noui Yassine Noui 1,3Samantha Bayhonan Samantha Bayhonan 1Beatrix Sari Beatrix Sari 1Yee Mah Yee Mah 1,4
  • 1 King's College Hospital NHS Foundation Trust, London, United Kingdom
  • 2 St Georges Hospital, Morpeth, United Kingdom
  • 3 Uppsala University, Uppsala, Uppsala, Sweden
  • 4 School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, England, United Kingdom

The final, formatted version of the article will be published soon.

    Early Neurological Deterioration (END) following acute stroke is associated with worse longterm functional outcomes. END is poorly defined and its relationship to reperfusion therapies is not fully understood. NIHSS is commonly used to risk-stratify and identify END following acute stroke however its relationship to END is relatively unexplored. The electronic health record of 933 stroke patients admitted to the Hyperacute Stroke Unit at King's College Hospital in 2022 were manually reviewed for END up to 14-days post stroke to: 1) characterise aetiology and risk factors associated with END following acute stroke, and 2) evaluate the association between END, reperfusion therapy and NIHSS. Age, sex and co-morbidity were not associated with END, whereas reperfusion therapy was associated with greater END risk. Admission NIHSS was associated with END in those receiving conventional therapy alone, however, was not associated with END in those receiving reperfusion therapy. For those receiving IVT or EVT, the change in NIHSS at 24hours was associated with END whereas admission NIHSS was not. In patients with a stable NIHSS 24-hours post stroke, there remained a greater than 10% risk of END. In conclusion, demographic factors and co-morbidity appear less important in determining END risk than stroke severity and treatment type. Admission NIHSS had limited association with END risk in those undergoing reperfusion therapy whereas the change in NIHSS at 24hours was useful. NIHSS alone appears insufficient in its sensitivity to END to act as a riskstratification tool, as significant END risk remains in those with stable or improving NIHSS.

    Keywords: acute stroke, endovascular thrombectomy (EVT), Intravenous thrombolysis (IVT), early neurological deterioration (END), National Institute of Health Stroke Scale (NIHSS score), reperfusion therapies

    Received: 28 Oct 2024; Accepted: 08 Jan 2025.

    Copyright: © 2025 Lee, Yu, Mallah, Belo, Recaman, Noui, Bayhonan, Sari and Mah. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Cameron Lee, King's College Hospital NHS Foundation Trust, London, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.