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STROKE-PROGNOSTIC FACTORS

Neurology

STROKE-PROGNOSTIC FACTORS

1. Age: younger patients demonstrate greater neurological and functional recovery and hence have a better prognosis.

2. Presentation (poor prognosis): delayed presentation, delayed rehabilitation, premorbidly dependent (patient admitted from nursing home), decreased consciousness.

3. Medical comorbidities (poor prognosis): arrhythmias, previous stroke, DM, cardiac disease, previous disability, alcohol abuse.

4. Stroke severity & size: more severe and larger size confer poorer prognosis.

5. Stroke type: hemorrhagic (better long-term prognosis) vs. ischemic (poorer long-term prognosis).

6. Stroke site: bilateral hemispheres (poor prognosis), brainstem involvement (poor prognosis), right hemisphere (poor prognosis).

7. Deficits (poor prognosis): neglect, sensory & visual deficits, global aphasia (poor long-term prognosis), poor sitting balance, incontinence (if persists > 1-2 weeks).

8. Trunk balance (sit independently > 30sec). Non-ambulant patients who regained sitting balance and some voluntary movement of the hip, knee and/or ankle within the first 72 hours post stroke predicted 98% chance of regaining independent gait within 6 months.

9. Timing of recovery of hand movement: good prognosis (70% chance of recovery) in patients who recover hand function within 4 weeks of stroke.

10. Severity of UL deficit at onset: poor prognosis of UL recovery in patients with complete paralysis of the hand.
- No measurable grasp reflex at 4 weeks.
- Prolonged flacidity period.
- Severe proximal spasticity.
- Late return of proprioceptive facilitation response (tapping) > 9 days.
- Late return of proximal traction response (shoulder flexors/adductors) > 13 days.

11. Low score on Barthel index at time of rehabilitation discharge: poor long-term prognosis.

12. Prolonged rehabilitation length of stay: poor long-term prognosis.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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