Objectives: Despite the rising incidence of early-onset acute ischemic stroke (AIS) in India, evidence on outcomes and predictors of early neurological deterioration (END) among young adults remains scant. We aimed to evaluate the association of National Institutes of Health Stroke Scale (NIHSS)-defined END with mortality and functional dependency among young adults with AIS and to identify the clinical, radiological, laboratory, and treatment-related factors contributing to END. Materials and Methods: In this prospective observational cohort study of young adult (18–49 years) patients with AIS, we determined the association of END with functional dependency (assessed using modified Rankin scale mRS) and analyzed clinical, imaging, laboratory, and treatment-related data from 52 patients presenting within 4.5-hours of last known well. END was defined as a ≥2-point NIHSS increase or ≥1-point motor worsening within 7 days of the index event. Predictors were identified using modified Poisson multivariate and least absolute shrinkage and selection operator (LASSO) regression models. Results: The median interquartile range age of the cohort was 42 (31–46) years. END occurred in 21 (40.4%) patients and caused greater functional dependency (mRS, 3–6) compared to those without END (adjusted odds ratio 4.89 95% confidence interval 1.48–11.10, p = 0.008). Hypertension (adjusted risk ratios aRRs 2.98, p = 0.047), Glasgow Coma Scale ≤12 (aRR 2.56, p = 0.023), and Alberta stroke program early computed tomography score ≤7 (aRR 1.48, p = 0.051) were identified as independent predictors of END. Anterior cerebral artery involvement (β = +1.92), hyperhomocysteinemia >15 µmoL/L (β = +0.68), male sex (β = +0.59), hypoalbuminemia (β = +0.55), and middle cerebral artery involvement (β = +0.22) showed positive prediction scores for END in LASSO models. Conclusion: END occurred in 2 of every 5 young adult patients with AIS, with large-vessel occlusion as the major predictor, and poor short-term outcomes were documented in more than half. Hypertension and index-event hyperglycemia emerged as modifiable risk factors. Distinct predictors of END underscore the importance of early recognition for targeted acute interventions.
Suryawanshi et al. (Wed,) studied this question.