Clinical and Radiological Characteristics of Acute Ischemic Stroke
Consulted from Nonneurology Departments

J Korean Neurol Assoc > Volume 32(3); 2014 > Article

Journal of the Korean Neurological Association 2014;32(3): 158-162.

타과에서 의뢰된 급성뇌경색의 임상과 영상 특징

유상원, 김승유 배대웅 김우준 조아현

가톨릭대학교 의과대학 신경과학교실

Clinical and Radiological Characteristics of Acute Ischemic Stroke Consulted from Nonneurology Departments

Sangwon Yoo

Department of Neurology, School of Medicine, Catholic University of Korea, Seoul, Korea

Abstract

Background: An acute ischemic infarction can occur in patients admitted to a nonneurology department, which can result in a delay in the diagnosis that could produce a poor outcome. The aim of this study was to identify the clinical and radiologic features of ischemic stroke diagnosed during consultations in nonneurology departments.
Methods: Acute ischemic stroke patients who were admitted to a neurology department or who were diagnosed after a consultation to a neurology department between October 2007 and February 2009 were enrolled. Acute ischemic stroke was diagnosed by a stroke neurologist with the aid of diffusion-weighted MRI. Clinical variables [age, sex, risk factors, initial score on the National Institutes of Health Stroke Scale, stroke subtype, and modified Rankin scale (mRS) score at 3 months] were obtained. Poor clinical outcome was defined as a mRS score of 3-6. Stroke lesion types based on MRI were classified into single vascular territory, multiple vascular territories, and multiple circulations.
Results: In total, 340 patients were enrolled, 84 (24.7%) of whom were diagnosed in nonneurology departments. Among the 84 consultations, 57 cases were symptomatic ischemic strokes, and 27 cases exhibited irrelevant acute ischemic lesions. With respect to the stroke subtype, other cause (10.7% vs 4.8%) and undetermined cause (42.9% vs 20.7%) were more common in the nonneurology department patients (p<0.0001). Acute ischemic strokes in multiple circulations were also more common in those from nonneurology departments (44.0% vs 11.0%, p<0.0001), along with higher high-sensitivity C-reactive protein levels. A poor clinical outcome was more common among patients in the nonneurology departments than among those in the neurology department (75.0% vs 27.5%, p<0.0001).
Conclusions: Ischemic strokes from nonneurology departments tend to appear as nonlocalizing neurologic symptoms and spread in multiple circulations, and are associated with a worse outcome than those from neurology departments. Key Words: Ischemic stroke, Stroke subtypes, Stroke lesion types, Consultation, Nonneurologists