NEW YORK (Reuters Health) – Patients with marked clinical fluctuation in neurologic status due to cerebral ischemia may benefit from thrombolytic therapy, researchers from Canada report in the Archives of Neurology for August.

Until now, the value of thrombolysis in this setting was unclear, Dr. Ozcan Ozdemir and colleagues from London Health Science Centre, Ontario, note in the report.

Among 127 patients who received intravenous or intra-arterial recombinant tissue plasminogen activator, Dr. Ozdemir’s team found that 13 (10.2%) had clinical fluctuations in neurologic status during the immediate stage of stroke. They defined fluctuation of neurologic status as a 4-point or greater increase or decrease in the National Institutes of Health Stroke Scale (NIHSS) score.

Patients with fluctuations presented with a lower baseline NIHSS score than patients without fluctuations (median score 7 versus 12; p < 0.001).

According to the investigators, “fluctuation of symptoms or signs ceased after thrombolysis.”

Follow-up cranial magnetic resonance imaging or computed tomography performed 24 hours after the initial event showed ischemic infarction in all patients with fluctuations.

“Despite this, remarkably good neurologic outcome was observed after thrombolysis in all patients at 3 months,” the team reports. “Our patients did not have any recurrent stroke or transient ischemic attack within 90 days after acute stroke.”

Dr. Ozdemir and colleagues say two limitations of the study are the fact that it included only a few patients, and information about patients with fluctuations who did not receive thrombolytic therapy was not collected.

Nonetheless, they say their observations suggest that “withholding or delaying thrombolytic therapy in patients with fluctuations is not warranted.”

Reference:
Arch Neurol 2008;65:1041-1043.