How are prognostic predictors used in treatment planning following middle cerebral artery (MCA) stroke, and how are plaque burden and substance P levels associated with prognosis?

Updated: Mar 17, 2020
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

An important role for the physiatrist, as well as the neurologist, in the postacute care of stroke patients is to discern prognosis based on predictors available. Such assessment is vital in planning and selecting appropriate rehabilitation and in preparing the patient and family for adjustments and adaptations needed to accommodate resultant disability. Early predictors include stroke severity in terms of extent on radiologic studies, National Institutes of Health Stroke scores in the acute setting, age, and other medical comorbidities. Later predictors include social support, bowel and bladder continence, trunk stability, presence of visuospatial disorders such as neglect, and flaccid paralysis. [26, 91]

Using magnetic resonance vessel wall imaging, a study by Ran et al indicated that in persons with ischemic stroke related to middle cerebral artery (MCA) plaque, those with recurrent stroke tend to have a higher plaque burden than do individuals with a first episode of acute stroke and patients with chronic stroke. [92]

A study by Lorente et al indicated that in patients with malignant MCA infarction, higher levels of serum substance P concentrations on days 1, 4, and 8 of the infarction are predictive of 30-day mortality. [93]


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