Title : Evaluation of anterior versus posterior circulation acute ischemic stroke with clinico-topographic correlations and relationship with early mortality-based scale predictions
Abstract:
Background: Posterior circulation ischaemic strokes (PCIs) are a clinical syndrome associated with ischemia or embolic occlusion of posterior circulation and differ from anterior circulation ischaemic strokes (ACIs) in many aspects. In this study, ACIs and PCIs were evaluated in terms of clinico-radiological and demographic aspects, and the relevance of objective scales to early disability and mortality was investigated.
Methods: 100 acute ischemic stroke patients were included in the first 24 hours. The definition of ACIS or PCIS was classified according to the Oxfordshire Community Stroke Project (OCSP). Arrival NIH Stroke Scale/Score (NIHSS) and Glasgow Coma Scale (GCS) and Modified SOAR Score (mSOAR) were evaluated for early clinical scores and mortality-based scale. All data were compared, and mean, median(IQR) values, and ROC curve analysis were determined.
Results: Hypertension was the most common disease for both groups. The second one was hyperlipidemia (82%) in the ACIs and diabetes mellitus (40%) in the PCIs. The frequency of right hemisphere ischemia was higher in ACIs (63.6%) and PCIs (48%). The mean NIHSS and GCS score (also median IQR) were higher in the right ACIs (median(IQR):9.5(13). The highest NIHSS mean was in the right PACS (median(IQR):14.5(3)). The mean NIHSS and GCS score of bilateral POCs was the highest in PCIs (median(IQR):3(17), median(IQR):15(4) respectively). The mSOAR mean was the highest in the right PACs and bilateral POCs (median(IQR):2.5(2), (median(IQR):2(2) respectively).
Conclusion: The association of PCIs with hyperlipidemia and the male gender was interpreted, and anterior infarcts were found to cause higher early clinical disability scores. The NIHSS scale was effective and reliable, especially in acute anterior strokes, but also emphasized the necessity of using the GCS assessment together in the first 24 hours to assess PCIs. mSOAR scale is a helpful predictor in estimating mortality not only in ACIs but also in PCIs, similar to GCS.
Keywords: Modified SOAR Score for Stroke; NIH Stroke Scale; Posterior Circulation Brain Infarction; Topographic Imaging
Audience Take Away
- Acute Ischemic Stroke is the first acute neurologic pathology in the order of life-threatening-mortality
- Clinic-topographic value in AIS is essential in the selection of care, prognosis, and treatment
- PCI's diagnosis differs from AIS in terms of topographical and mortality
- NIHSS is one of the parameters that can be used safely in anterior strokes
- When evaluating PCIs, the GCS and mSOARo scales should be evaluated together with the NIHSS
