Key result
Numbness is linked to lower dependence or death in minor stroke, while motor deficits predict risk.
Why the study?
Predicting the small proportion of acute ischemic stroke patients with minor deficits who experience poor outcomes could help guide reperfusion therapy decisions.
In patients with minor acute ischemic stroke, presenting symptoms such as walking difficulty and leg weakness are associated with long-term functional dependence, which may help guide reperfusion therapy decisions.
May aid prognostication in minor AIS; leaves open whether symptoms should influence reperfusion decisions.
Background: Predicting the small proportion of acute ischemic stroke (AIS) patients with minor deficits (NIHSS<6) who may have poor outcomes could help guide AIS reperfusion decisions in this population. Using a population-based study, we aimed to identify presenting symptoms and NIHSS deficits associated with 1) functional dependence or death (mRS 3-6) after minor AIS and 2) worse health-related quality of life in minor AIS patients functionally independent (mRS < 2) after stroke. Methods: We ascertained all hospitalized adult ( > 18 years) AIS patients presenting to an ED in the Greater Cincinnati/Northern Kentucky region in 2020. Cases were identified by ICD codes and were adjudicated by physicians. Clinical data was abstracted by trained research nurses, including presenting symptoms, initial NIHSS, 3-month mRS, and 3-month health-related quality of life (EQ5D-3L). This analysis included only AIS patients with an initial NIHSS<6 and pre-stroke mRS ≤2 who survived their initial hospitalization and were not discharged to hospice. Multivariable logistic models with least absolute shrinkage and selection operator (Lasso) were used to identify presenting symptoms and NIHSS sub-scores associated with functional dependence/death (mRS 3-6) 3 months after stroke. Linear regression with Lasso was used to explore presenting symptoms and NIHSS sub-scores associated with EQ5D-3L index scores (ranging from 0-1 with lower scores indicating worse quality of life) in patients who reached functional independence (mRS < 2) 3 months after stroke. Results: We identified 1170 minor AIS patients with 3-month mRS available (Graphic 1), of which 317 (27%) were functionally dependent/dead 3 months after stroke (Graphic 2). Numbness as a presenting symptom was associated with lower odds of functional dependence/death (Graphic 3). Walking difficulty/falling and NIHSS sub-score of leg weakness were associated with higher odds of functional dependence/death (Graphic 3). Health-related quality of life was relatively good in patients reaching functional independence 3 months after stroke (n=787 with EQ5D data available, median EQ5D index score 0.85, IQR 0.83-1.0) No presenting symptoms or NIHSS sub-scores were associated with EQ5D index values. Conclusion: Our findings could help clinicians in the often-difficult task of determining disabling symptoms and deficits that could potentially cause long-term dependency when considering AIS reperfusion therapies for minor AIS patients.
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Wechsler et al. (2026) studied this question. Numbness at presentation was linked to lower odds of functional dependence/death, while walking difficulty and leg weakness increased those odds in minor acute ischemic stroke patients.
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