Patient characteristics associated with delayed neurological improvement following acute ischemic stroke: A systematic review and meta-analysis

Hassan Kobeissi, Sherief Ghozy, Trey J. Seymour, Cem Bilgin, Michael Liu, Ramanathan Kadirvel, Waleed Brinjikji, Alejandro A. Rabinstein, David F. Kallmes

Research output: Contribution to journalReview articlepeer-review


Background: Delayed neurological improvement (DNI) is a phenomenon that involves patient improvement in the absence of early neurological change following treatment for acute ischemic stroke. The patient characteristics associated with this condition are largely unexplored. Methods: Following the PRISMA guidelines, a systematic review of the English language literature was conducted using PubMed, Embase, Web of science, and Scopus. We calculated pooled odds ratios (ORs), mean differences (MDs), and their corresponding 95% confidence intervals (CIs) to test the association between patient characteristics and achievement of DNI. Results: Seven studies, with 3266 patients, were included in our analysis. All studies reported a different definition of DNI, with five studies focusing on rates of good functional outcome at 90 days post-treatment in the absence of early neurological improvement. Use of intravenous thrombolytics was associated with increased rates of DNI (OR 1.96, 95% CI 1.28 to 3.00; p = 0.002). Atrial fibrillation was associated with decreased rates of DNI (OR 0.69, 95% CI 0.57 to 0.82; p < 0.001), as was hypertension (OR 0.66, 95% CI 0.53 to 0.83, p < 0.001), and diabetes mellitus (OR 0.71, 95% CI 0.56 to 0.90; p = 0.005). On average, patients who achieved DNI were 6.30 years younger than their non-DNI counterparts (MD −6.30, 95% CI −9.19 to −3.41; p < 0.001). There were modest associations between male sex and DNI (OR 1.36, 95% CI 1.01 to 1.74, p = 0.042), and smoking and DNI (OR 1.28, 95% CI 1.03 to 1.59, p = 0.027). Conclusions: DNI is a phenomenon that is not presently well understood. Lack of uniformity among definitions of DNI hinders efforts to explore DNI and the factors associated with its occurrence. Future studies should work to establish a consensus definition of DNI to determine its causes and significance more accurately.

Original languageEnglish (US)
JournalInterventional Neuroradiology
StateAccepted/In press - 2023


  • delayed neurological improvement
  • mRS
  • stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Patient characteristics associated with delayed neurological improvement following acute ischemic stroke: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this