Mild stroke: safety and outcome in patients receiving thrombolysis Logallo N, Kvistad CE, Naess H, Waje-Andreassen U, Thomassen L. Mild stroke: safety and outcome in patients receiving thrombolysis. Acta Neurol Scand: 2014: 129 (Suppl. 198): 37–40. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objectives – The aim of this study was to compare the short-term clinical outcome of patients with acute cerebral ischemia and mild symptoms receiving rt-PA with that of patients with acute cerebral ischemia and mild symptoms not treated with rt-PA, and to investigate the frequency of symptomatic intracranial hemorrhage (sICH) in these patients. Materials and methods – All patients with confirmed ischemic stroke/TIA and mild symptoms were included. Mild symptoms were defined as NIHSS score ≤5 on admission. Functional outcome was assessed with modified Rankin Scale (mRS) at day 7 or at earlier discharge. Excellent outcome was defined as mRS = 0. sICH was defined according to both NINDS and ECASS III criteria. Results – Of 2753 patients with confirmed ischemic stroke/ TIA admitted between February 2006 and February 2013, 966 (35.3%) were excluded because of having admission NIHSS >5. A total of 1791 patients presented with mild symptoms on admission (NIHSS ≤5), of which 158 (8.8%) patients received rt-PA. Treatment with rt-PA and early admission were independently associated with excellent outcome. Higher NIHSS score on admission and prior ischemic stroke were independently associated with poor outcome. Three (1.9%) sICH were diagnosed in rt-PA-treated patients and one (0.1%) in patients not receiving rt-PA. Conclusions – This study highlights the efficacy of rt-PA in patients with acute cerebral ischemia presenting with mild symptoms and confirms the low-risk profile of this treatment. N. Logallo 1 , C. E. Kvistad 2 , H. Naess 1,2,3 , U. Waje-Andreassen 2 , L. Thomassen 1,2 1 Department of Clinical Medicine, University of Bergen, Bergen, Norway; 2 Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway; 3 Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway Key words: mild stroke; intravenous thrombolysis; stroke epidemiology; stroke outcome N. Logallo, Department of Clinical Medicine, University of Bergen, Jonas Liesvei 65, 5021 Bergen, Norway Tel.: +47 97 13 20 26 Fax: +47 55 97 51 64 e-mail: nicola.logallo@gmail.com Accepted for publication December 2, 2013 Introduction There are no specific recommendations for use of recombinant tissue-type plasminogen activator (rt-PA) in stroke patients with mild or rapidly improving symptoms (1, 2). Mild or rapidly improving symptoms are one of the major reasons for withholding rt-PA in time-eligible patients (3, 4) because of concern about symptomatic intra- cranial hemorrhage (sICH). However, this risk appears to be low (5), and one-third of patients with mild stroke not receiving rt-PA fail to recover and have an unfavorable outcome [modi- fied Rankin Scale (mRS) ≥2] (6). In addition, many patients with mild stroke symptoms fail to be admitted within the rt-PA time window due to neglection of stroke symptoms. The criteria for mild or rapidly improving symptoms are also weak and often defined as isolated sensory loss, ataxia, facial weakness, or dysarthria (7). The most common definition of mild stroke in research studies is clinical deficits measured as up to 3 or 5 points on the National Institutes of Health Stroke Scale (NIHSS) (8). The aim of this study was to compare the short-term clinical outcome of patients with acute cerebral ischemia and mild symptoms receiving rt-PA with that of patients with acute cerebral ischemia and mild symptoms not treated with rt- PA, and to investigate the frequency of sICH in these patients. Material and methods All patients with acute cerebral infarction or tran- sient ischemic attack (TIA) and mild symptoms 37 Acta Neurol Scand 2014: 129 (Suppl. 198): 37–40 DOI: 10.1111/ane.12235 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA