Abstract TP214: Progression of Stroke Deficits in Patients Presenting With Mild Symptoms: The Underlying Etiology Determines Prognosis

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Introduction: Many acute stroke patients present with mild symptoms, make it difficult to determine whether they should be treated with reperfusion strategies or not. The symptoms of such patients may frequently show progression. We hypothesized that localization based on clinical examination and multi-model imaging will be very helpful in determining patients most likely to have a bad outcome. Methods: We interrogated the Hamad Stroke Database to evaluate 90-days outcome in patients with acute ischemic stroke admitted within 4 hours and a NIHSS score of ≤6. Patients were evaluated based on the localization (lacunar or cortical), abnormalities on multi-model imaging and whether they were treated with rt-PA or not. The 90-day mRS was used to determine outcome. Results: During the study period 4016 patients were admitted with acute stroke. Mild stroke with arrival within 4 hours was diagnosed in 365 patients [no thrombolysis: 269 (lacunar: 155; cortical: 114), thrombolysis: 96 (lacunar: 38; cortical: 58)]. The rt-PA treated patients had significantly higher NIHSS (4.8±1.2 versus 2.3±1.6, p<0.0001), increased risk of complications (18.8% versus 4.1%, p<0.001) and longer hospital stay (median -Inter quartile range- 4 {2-6} versus 3 {2-5} days, p=0.002). Imaging abnormalities, including intracranial arterial occlusions and CTP mismatch were more frequent in rt-PA treated patients. The mRS at discharge (36.5% versus 14.8%, p<0.001) and 90 days (24% versus 12.6%, p=0.009) was significantly worse in patients with both cortical stroke in rt-PA-treated and untreated patients. Conclusions: The prognosis in patients with mild stroke depends on location of the lesion (lacunar versus cortical). Patients who receive rt-PA have significantly larger deficits, increased imaging abnormalities and higher rates of complications that may explain the poor prognosis in such subjects.

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