Differences in subacute motor recovery after intracerebral haemorrhage and ischaemic stroke: Analysis using the VISTA database cohort

Abstract

Background

Motor impairment is a significant contributor to disability after stroke, but recovery is often incomplete. Whether motor recovery differs between intracerebral haemorrhage (ICH), a subgroup of stroke with far worse outcomes, and ischaemic stroke is not clear.

Methods

We performed a retrospective observational longitudinal cohort study using individual patient-level data from the Virtual International Stroke Trials Archive (VISTA) database (ICH n=892, ischaemic stroke n=6912). Differences in motor recovery to 90-days were examined between ICH and ischaemic stroke patients with mixed effect regression models adjusted for a priori determined confounders. Motor weakness was measured by NIHSS face, arm and leg sum with secondary analyses of total NIHSS, and NIHSS language score.

Results

Recovery was observed in all NIHSS domains for both stroke types to 30-days (NIHSS_motor b=-2.78, 95%CI -2.89,-2.68; NIHSS_total b=-5.74, 95%CI -5.92,-5.56; NIHSS_language b=-0.28 95%CI -0.31,-0.24) and 90-days (NIHSS_motor b=-3.62, 95%CI -3.69,-3.54; NIHSS_total b=-7.17, 95%CI -7.30,-7.05; NIHSS_language b=-0.74, 95%CI -0.78,-0.71). Baseline impairment between groups was well matched with only motor impairment being slightly greater in ICH; NIHSS_motor mean(SD)=13.0 (5.3) vs 12.3 (5.4). To 30-days the extent of recovery was not different between stroke types but recovery to 90-days was greater in ICH for motor and statistically significant for total NIHSS score (b=-0.35, 95%CI -0.71,-0.002). Ischaemic stroke survivors recovered more in NIHSS language domain.

Conclusions

Timing and extent of recovery is different between stroke types. Motor recovery in ICH is greater and occurs later. Therefore, the assumption that most recovery occurs within 30-days and proportionality of recovery should be revisited in this population.