Characteristics of early neurological deterioration in minor non-disabling ischemic stroke patients

Abstract Background The benefit of intravenous thrombolysis (IVT) in minor ischemic stroke patients still is controversial. Objective The incidence and risk factors of early neurological deterioration (END) in minor non-disabling patients were determined. Methods The data was obtained from minor ischemic stroke patients in our hospital from July 2019 to March 2025. Minor non-disabling stroke was identified as patients with the National Institutes of Health Stroke Scale (NIHSS) score ≤ 3. The neurological deficits did not prevent patients from performing basic activities of daily living (ADL) (such as bathing, ambulating, toileting, hygiene, and eating) according to the initial ADL scores and descriptions found in the medical records. END was defined as an increase in the total NIHSS score ≥ 2 over the baseline within 72 h of the stroke onset. Furthermore, at least one component of the increase in the total NIHSS score was an increase that was ≥ 1 in movement ability (5a-6b) or consciousness level (1a-1c) or new onset neurological deficits. Results Among 831 minor AIS patients, we retrospectively identified 326 (39.2%) minor non-disabling AIS patients, of whom 42 (12.9%) patients experienced END. Forty-eight (14.7%) patients experienced large vessel stenosis or occlusion. One hundred fourteen patients accepted intravenous thrombolysis. In entire minor non-disabling patients, large vessel stenosis or occlusion (31% vs. 12.3%, P 1 = 0.004; OR 3.176, 95% CI1.457–6.926, P 2 = 0.004) was independently associated with END. Through subgroup analysis, we also found that large vessel stenosis or occlusion (33.3% vs. 13.7%, P 1 = 0.014; OR 3.681, 95% CI1.477–9.173, P 2 = 0.005) was independently associated with END in the patients without IVT. However, among the patients with IVT, no significant association of large vessel stenosis or occlusion (25.0% vs. 9.8%, P 1 = 0.139; OR 2.828, 95% CI ,0.564–14.180, P 2 = 0.206) was found in END. Conclusion Large vessel stenosis or occlusion was independently associated with END in entire minor non-disabling patients or the patients without IVT. However, among the patients with IVT, no significant association of large vessel stenosis or occlusion was found in END. In other words, IVT might work in preventing these special patients from END.