[WEB SITE] Stroke prognosis in adults

INTRODUCTION — Stroke is the third most common cause of disability and second most common cause of death worldwide (see “Etiology, classification, and epidemiology of stroke”, section on ‘Epidemiology’). Clinicians are often asked to predict outcome after stroke by the patient, family, other healthcare workers, and insurance providers. A wide variety of factors influence stroke prognosis, including age, stroke severity, stroke mechanism, infarct location, comorbid conditions, clinical findings, and related complications. In addition, interventions such as thrombolysis, stroke unit care, and rehabilitation can play a major role in the outcome of ischemic stroke. Knowledge of the important factors that affect prognosis is necessary for the clinician to make a reasonable prediction for individual patients, to provide a rational approach to patient management, and to help patient and family understand the course of the disease.

This topic will review the factors that affect stroke prognosis, with a focus on the acute phase of ischemic stroke. The prognosis of intracerebral hemorrhage and subarachnoid hemorrhage is reviewed separately. (See “Treatment of aneurysmal subarachnoid hemorrhage”, section on ‘Prognosis’ and “Spontaneous intracerebral hemorrhage: Treatment and prognosis”, section on ‘Prognosis’.)

MAJOR PREDICTORS — In the acute phase of stroke, the strongest predictors of outcome are stroke severity and patient age. Stroke severity can be judged clinically, based upon the degree of neurologic impairment (eg, altered mentation, language, behavior, visual field deficit, motor deficit) and the size and location of the infarction on neuroimaging with MRI or CT. Other important influences on stroke outcome include ischemic stroke mechanism, comorbid conditions, epidemiologic factors, and complications of stroke.

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