Abstract Details

Title Dehydration Is Associated with More Severe Hemispatial Neglect after Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S02 - (-)

Poster/Presentation
Number 004

Objective

Background Stroke patients with hemispatial neglect have a difficult rehabilitation course, which may be impacted by medical factors occurring at the time of the stroke. Dehydration may lead to a state of hyperviscosity, which may cause blood sludging, RBC aggregation, and platelet activation, contributing to thrombosis. These processes may impact perfusion of the ischemic penumbra thus leading to stroke progression and worsened outcomes. We hypothesized that patients with dehydration at time of presentation have more severe stroke symptomatology as defined by the presence of neglect.

Design/Methods Consecutive non-demented English-speaking right-handed patients with acute right hemispheric ischemic stroke were evaluated with brain MRI. Severe neglect (Z-score?2 on 3 neglect tests) was the dependent variable in logistic regressions evaluating the role of admission BUN/creatinine ratio and, in a smaller subset, urine specific gravity (SG), with adjustment for age, sex, DWI volume, and NIHSS. Dehydration was defined as an elevated BUN/creatinine (?15) with an elevated urine SG (?1.010).

Results Among 216 individuals who met inclusion criteria, having an elevated BUN/Creatinine ratio was associated with 3.96-times higher odds of having severe neglect (95% CI 0.88-17.75). Independent of creatinine, BUN level was associated with severe neglect (adjusted OR 1.11, 95% CI 1.01-1.22, per point higher BUN). All individuals with severe neglect had an elevated urine SG (p=0.047; N=120).

Conclusions Patients who are dehydrated at the time of presentation with stroke have more severe stroke symptoms, independent of stroke severity. This represents an opportunity to evaluate our hydration practices in patients with varying degrees of cardiac dysfunction during the acute stroke period in order to prescribe more precise fluid resuscitation algorithms. Future clinical trials designed to evaluate fluid resuscitation practices at the time of ischemic stroke are needed.

Authors/Disclosures
Mona Bahouth, MD, PhD, FAAN (Johns Hopkins School of Medicine) PRESENTER	The institution of Dr. Bahouth has received research support from NIH.
	No disclosure on file
Argye E. Hillis, MD, MA (Johns Hopkins Hospital)	Dr. Hillis has received personal compensation for serving as an employee of Johns Hopkins University. Dr. Hillis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Hillis has received research support from NIH. Dr. Hillis has received publishing royalties from a publication relating to health care. Dr. Hillis has received personal compensation in the range of $500-$4,999 for serving as a NIDCD Council Member with NIH.
Rebecca F. Gottesman, MD (Johns Hopkins University)	The institution of Dr. Gottesman has received research support from NIH.
Charles A. Szabo, MD, FAAN (UT Health San Antonio)	Dr. Szabo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LivaNova. Dr. Szabo has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Epilepsy Foundation of Central and South Texas. Dr. Szabo has received personal compensation in the range of $0-$499 for serving as a Reviewer with NINDS.

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