Spontaneous early improvement following ischemic stroke

Background and Purpose: Recognizing that early spontaneous neurological improvement not uncommonly follows acute ischemic stroke, we conducted this study to determine the incidence of such improvement and its potential relation to stroke etiology. Methods: We prospectively evaluated 68 patients who presented within 12 hours after ischemic stroke, exhibited moderate or severe new functional neurological deficit acutely, and received either no stroke-specific therapy or only antiplatelet therapy over the ensuing week. We reexamined all patients 1 week after stroke onset. Results: Sixteen (24%) of the 68 patients improved to the point of having no or mild functional neurological deficit at 1 week. Patients with lacunar stroke were more likely to enjoy early spontaneous improvement (8/22=36% versus 8/46=17%), but this difference did not reach statistical significance (P=.15). Conclusions: Early spontaneous improvement after ischemic stroke may occur in a substantial proportion of patients and more commonly after lacunar stroke. Even so, the majority of patients with acutely disabling stroke will remain significantly impaired 1 week after stroke onset.