SHORT-TERM OUTCOME OF CARDIOEMBOLIC STROKE IN DIFFERENT AGE GROUPS

Abstract

Background: The heart is established as an important source of cerebral embolism. Cardioembolic stroke (CES) accounts for about 20% of all ischaemic strokes. Various cardiac conditions either major or minor sources have been clearly associated with an increased risk of ischaemic stroke. Outcome and prognosis in cardioembolic ischaemic stroke are affected by different demographic, clinical, laboratory, and radiological parameters.
Objectives: The aim of this work was to study short-term neurological outcome of cardioembolic ischaemic stroke patients during the first six weeks following stroke onset in different age groups.
Methods: Forty patients with first-ever cardioembolic ischaemic stroke (23 males and 17 females) divided according to their ages into four groups (group I less than 20 years, group II 20-<40 years, group III 40-<60 years and group IV >60 years). Those were included in a hospital-based follow up prospective study and were subjected to clinical assessment, cardiological evaluation, CT/MRI measurement of brain infarction, patients were followed up for 6 weeks. Stroke severity was assessed by mNIHSS, GCS and CANS and functional outcome as assessed by mRS. Also sensitivity and specificity of these scales were assessed. The results were compared in different age groups.
Results: A highly statistically significant improvement in mean scores of mRS between the first and fifth visit were only recorded in young age groups I, Π and Ш of CES patients denoting improvement of functional outcome during the follow up visits of study period (p<0.001), while the old age group IV (60-80 years) didn't show any statistical difference in mean values of mRS during follow up visists. A highly statistical significant increase of vascular comorbidity in older age groups than younger ones (100%, 100% in group Ш, ΙV vs 0.0%, 10% in group Ι, Π, p=0.001) was recorded. Patients with AF and IHD had statistically significant more severe strokes as assessed by CANS and m NIHSS than those with RVHD (77.3% of AF and 78.6% of IHD had CANS score <6.5 Vs 38.5% of RVHD, P=0.03), (72.7% of AF, 71.4% of IHD had mNIHSS score ≥ 12 Vs 30.8% of RVHD, P=0.03). Regarding functional outcome, death (m RS =6) was significantly higher in AF patients (36.4% in AF, 35.7% in IHD, and 0.0% in RVHD, P=0.04). A significant positive correlation between initial neurological severity as assessed by mNIHSS and functional outcome by mRS at the end of the study period in CES patients. (p=0.01). GCS was found to be the most accurate stroke severiy scale in predicting outcome (50% sensitivity, 100% specificity with positive predictive value of 100.0 and accuracy of 85.0%).
Conclusion: the overall short-term functional outcome of CES patients; in terms of (improvement ,disability and death) was significantly better in younger than older age groups reflecting the negative impact of age, difference in underlying cardiac source of cerebral embolism, comorbidity with other vascular risk factors and the complications between the two age groups on the functional outcome.
Key words: Cardioembolic, stroke, short-term outcome, age, scores.