Neurological deterioration and its risk score in total anterior circulation infarct.

OBJECTIVES: Specific factors and its predictive parameters for neurological deterioration in total anterior circulation infarct (TACI) were not known. Our objective was to determine the risk factors and risk scores for neurological deterioration in TACI. The secondary objective was to determine the effect of antiplatelet therapy in TACI. PATIENTS AND METHODS: This was a single-center cohort study. 46 patients with TACI were enrolled and followed up for 30 days, discharged, or death; whichever earlier. The National Institutes of Health Stroke Scale (NIHSS) was performed daily by investigators who are NIHSS certified and radiological findings were confirmed by a certified radiologist. Neurological deterioration was defined by a drop in NIHSS by 2 points or Glasgow Coma Scale (GCS) by 1 point. Clinical, laboratory and radiological variables were evaluated. Significant predictive variables were given a score based on its co-efficient values in multivariate analysis. RESULTS: Lower Alberta stroke program early CT score (ASPECTS) and higher numbers of early computed tomography (CT) sign of middle cerebral artery (MCA) infarct were significant risk factor for neurological deterioration with p < 0.001 (OR: 3.41, 95% CI 1.78-6.51) and p < 0.001 (OR 18.19, 95% CI 3.82-86.55) respectively. A score of 1 assigned for 3 early CT signs of MCA infarct, 2 for 4 early CT signs of MCA infarct, and 1 for ASPECTS < 6. Receiver operating characteristic (ROC) showed a total score of 2 predicted neurological deterioration in TACI (Area under the curve 0.953, with sensitivity and specificity of 78.9% and 93% respectively). CONCLUSION: A simple 2 variables risk score formula was significant in predicting neurological deterioration. Antiplatelet may be recommended for TACI, further study is required.

Can compressive thoracic cord lesions cause a pure lower motor neurone syndrome?

Compressive lesions of the spinal cord usually cause a syndrome of upper motor neurone weakness, spasticity and sensory loss below the level of the lesion. It has long been recognised that compressive cervical cord lesions may present as isolated lower motor neurone weakness of the upper limbs, a syndrome termed cervical spondylotic amyotrophy. We describe two patients presenting with isolated lower motor neurone weakness of the lower limbs in association with a compressive cord lesion at T11/12, a condition we have termed thoracic spondylotic amyotrophy.