Risk factors for unfavorable clinical course of the early recovery period of ischemic stroke in young and middle-aged patients

Background. This study was carried out due to persistent increase in the incidence of ischemic stroke in people of working age and insufficient knowledge of risk factors affecting its clinical course in the early recovery period in young and middle-aged patients.
The aim. To identify and to study variants of the clinical course of the early recovery period of ischemic stroke in young and middle-aged patients; to determine the risk factors for its unfavorable course.
Materials and methods. We carried out a longitudinal prospective study, which involved 145 patients with ischemic stroke in its early recovery period. The main risk factors for cardiovascular diseases were analyzed. Dynamic observation of these patients allowed us to determine five variants of the clinical course of the ischemic stroke early recovery period – regressive, regressive with residual mild focal neurological symptoms, stable, slowly progressive and rapidly progressive.
Results. Regressive course was observed in 58 (40 %) patients; regressive course with residual mild focal neurological symptoms – in 66 (45.5 %) patients; stable course – in 9 (6.2 %) patients; slowly progressive course – in 8 (5.5 %) patients, rapidly progressive course – in 4 (2.8 %) patients. The following risk factors had statistically significant affect on the unfavorable course of the disease: more pronounced motor, sensory and speech disorders at the time of patient’s admission to the hospital and at the end of the ischemic stroke early recovery period; severity of ischemic stroke according to the National Institutes of Health Stroke Scale (NIHSS); damage to the carotid basin of the brain; ischemic heart disease; irregular intake or patient’s refuse of taking prescribed antiplatelet, lipid-lowering, antihypertensive therapy (p < 0.05).
Conclusions. Defining the variant of the clinical course of the ischemic stroke early recovery period in young and middle-aged patients and risk factors for its unfavorable course is important in determining tactics and further neurorehabilitation measures.

1. Stakhovskaya LV, Kotov SV (eds). Stroke: Guidelines for physicians. Moscow: Meditsinskoe informatsionnoe agentstvo; 2018. (In Russ.).

2. Gusev EL, Skvortsova VL, Stakhovskaya LV. Stroke in the Russian Federation: Time for united concentrated activites. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2007; 107(8): 4-10. (In Russ.).

3. Piradov MA, Maksimova MYu, Tanashyan MM. Stroke. Stepby-step instruction. М.: ГЭОТАР-Медиа; 2019. (In Russ.).

4. Makarov AYu, Pomnikov VG (eds). Clinical neurology with the elements of medical and social expertise. Saint Petersburg: OOO «Zolotoy vek»; 1998. (In Russ.).

5. Sergeeva SP, Savin AA, Arkhipov VV, Gultyaev MM, Breslavich ID, Litvitsky PF. Prediction of the outcome of the acute phase of ischemic stroke: The role of apoptotic markers. Annals of Clinical and Experimental Neurology. 2017; 11(1): 21-27. (In Russ.).

6. Chernitsova NS, Kolmykova IuA, Kovalenko AV, Barbarash OL. Prediction of outcome of the acute period of ischemic stroke in young and middle-aged patients. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2014; 114(3-2): 55-59. (In Russ.).

7. Chen WC, Hsiao MY, Wang TG. Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit. J Formos Med Assos. 2022; 121(3): 670-678. doi: 10.1016/j.jfma.2021.07.009

8. Altuntas O, Tas S, Cetin A. An investigation of the factors that influence functional improvement in stroke rehabilitation. Turk J Med Sci. 2021; 51(3): 1448-1454. doi: 10.3906/sag-2101-94

9. Alferova MA, Mikhalevich IM, Rozhkova NYu. Fundamentals of applied statistics (using the Statistica program in medical research). Irkutsk: RIO IGIUV; 2005. (In Russ.).

10. Mikhalevich IM, Yurieva TN. Logistic regression and ROC analysis in the MEDCALC in the analysis of biomedical data. Irkutsk: IGMAPO; 2021. (In Russ.).