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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 4  |  Page : 561

Factors affecting functional recovery in ischemic stroke


Department of Neurological Sciences, Christian Medical College Hospital, Vellore, - 632004

Correspondence Address:
Department of Neurological Sciences, Christian Medical College Hospital, Vellore, - 632004
drsudhirkumar@yahoo.com



How to cite this article:
Kumar S. Factors affecting functional recovery in ischemic stroke. Neurol India 2003;51:561


How to cite this URL:
Kumar S. Factors affecting functional recovery in ischemic stroke. Neurol India [serial online] 2003 [cited 2019 Dec 15];51:561. Available from: http://www.neurologyindia.com/text.asp?2003/51/4/561/5049


Sir,
I read with interest the recent article by Paithankar et al.[1] They have determined the factors affecting functional recovery in ischemic stroke based on a prospective observational study. However, I would like to make some observations.
Firstly, there is a discrepancy in the exact number of patients included in the study. The abstract and the second sentence under “results” section show the number of patients as 72, whereas the first sentence under “results” section indicate that 74 patients were included in the study.
Though Paithankar et al have shown that patients with a severe neurological deficit (as determined by a Canadian Neurological Scale of £ 4) have a poorer outcome; it is not clear from their study, which of the neurological deficits correlate best with poor outcome. In a recent study, upper limb power of grade 3/5 or less and presence of aphasia correlated with greater disability at six months.[2]
95% of cases studied by Paithankar et al had anterior circulation stroke and therefore, the numbers are too small in the group with posterior circulation stroke to merit any comparison between the two groups (as done by the authors).
Paithankar et al have used CT scans to estimate the size of infarct. It is well known that CT may be negative in the acute phase of ischemic stroke. Moreover, the single largest diameter on CT did not correlate well with infarct volume in one study.[3] A high degree of interobserver variability has been observed in CT-based diagnosis and estimation of size of infarcts.[4] Therefore, diffusion-weighted MRI has been recommended for early diagnosis and estimation of infarct volume for stroke outcome studies.[4]
It should be noted however that clinical findings at presentation are the most important predictors of outcome, as the addition of one-week infarct volume to the information obtained by National Institute of Health Stroke Scale (NIHSS) did not improve the accuracy of predictive model of stroke outcome in a previous study.[5] 

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1.Paithankar MM, Dabhi RD. Functional recovery in ischemic stroke. Neurol India 2003;51:414-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Panicker JN, Thomas M, Pavithran K, Nair D, Sarma PS. Morbidity predictors in ischemic stroke. Neurol India 2003;51:49-51.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.van der Worp HB, Claus SP, Bar PR, Ramos LM, Algra A, van Gijn J, et al. Reproducibility of measurements of cerebral infarct volume on CT scans. Stroke 2001;32:424-30.  Back to cited text no. 3    
4.Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, et al. CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke 2002;33:2206-10.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Johnston KC, Wagner DP, Haley EC Jr, Connors AF Jr. RANTTAS Investigators. (Randomized Trial of Tirilazad Mesylate in Acute Stroke). Combined clinical and imaging information as an early stroke outcome measure. Stroke 2002;33:466-72.  Back to cited text no. 5    

 

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Online since 20th March '04
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