function. Several other prognostic models may be useful for predicting global outcome from acute ischemic stroke; however, none of the current models is established as generally valid, and none is widely used in clinical practice. These models include the ASTRAL score [148,149], DRAGON score [150], iScore [151,152], PLAN score [73], and CoRisk score [153]. These stroke prognostic models are intended to be easy to calculate from data available on admission. However, they disregard information available from follow-up and testing, such as stroke etiology, treatment, and complications, that has an important impact on outcome [81,154]. The course of stroke often changes in the first days after onset, and assessment at later times (eg, from 1 to 10 days after stroke onset) is likely to provide a more reliable prognosis [27]. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 12/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate INTERVENTIONS THAT IMPROVE OUTCOMES Interventions such as thrombolysis, mechanical thrombectomy, stroke unit care, and rehabilitation can play a major role in improving the outcome of ischemic stroke. The risk of stroke recurrence can be reduced by secondary prevention measures. Reperfusion therapy Reperfusion with intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke is discussed in detail separately. (See "Approach to reperfusion therapy for acute ischemic stroke" and "Intravenous thrombolytic therapy for acute ischemic stroke: Therapeutic use" and "Mechanical thrombectomy for acute ischemic stroke".) Stroke unit care The benefits of stroke unit care are reviewed elsewhere. (See "Initial assessment and management of acute stroke", section on 'Stroke unit care'.) Stroke rehabilitation The goals of stroke rehabilitation are to improve functional outcomes and to attain the highest level of independence that is possible despite persistent stroke-related neurologic deficits [155]. A variety of rehabilitation disciplines (eg, physical therapy, occupational therapy, speech and language therapy) employ exercises and compensatory and adaptive strategies to help patients improve function. Intense physical therapy (PT) and occupational therapy (OT) may be harmful if started very early (ie, in the first days after stroke) but they are generally considered beneficial at later time points [156,157]. Health care systems in most resource-rich countries offer inpatient rehabilitation services following acute hospitalization for patients with stroke who qualify. Inpatient rehabilitation typically starts around one week poststroke and may continue for two to six weeks or more depending on stroke severity. No large randomized clinical trials have demonstrated efficacy for inpatient rehabilitation therapy, but this remains difficult to study. Given the perceived value of inpatient rehabilitation by the public, health care providers, and policy makers alike, it would be considered unethical to conduct a study in which inpatient rehabilitation is withheld from a control group. While there is limited evidence to suggest early (started within three months poststroke) rehabilitation therapy is better [158], the few positive large rehabilitation trials were performed in the chronic phase (six months or more poststroke) [159,160]. Specifically, constraint-induced movement therapy in the chronic phase can improve motor impairment in the upper limb [159,161]. Vagus nerve stimulation paired with upper limb rehabilitation therapy is another promising approach for improving upper limb function in the chronic phase [162]. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 13/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Speech and language therapy is recommended for patients with aphasia [163], but no particular technique is established as effective [164]. The optimal timing, dose, and duration of various rehabilitation methods remains to be determined [155,163,165]. Rehabilitation should be individualized according to specific patient needs and available resources. Secondary prevention Most patients with an ischemic stroke or transient ischemic attack (TIA) should be treated with all available risk reduction strategies, including antithrombotic therapy, blood pressure control, statin therapy, and lifestyle modification; select patients with symptomatic cervical internal carotid artery disease may benefit from revascularization. These issues are addressed in separate UpToDate topic reviews: (See "Overview of secondary prevention of ischemic stroke".) (See "Early antithrombotic treatment of acute ischemic stroke and transient ischemic attack".) (See "Long-term antithrombotic therapy for the secondary prevention of ischemic stroke".) (See "Stroke in patients with atrial fibrillation".) (See "Early antithrombotic treatment of acute ischemic stroke and transient ischemic attack".) (See "Antihypertensive therapy for secondary stroke prevention".) (See "Low-density lipoprotein cholesterol-lowering therapy in the primary prevention of cardiovascular disease".) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 14/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate Basics topics (see "Patient education: Recovery after stroke (The Basics)") SUMMARY AND RECOMMENDATIONS Morbidity and mortality The estimated 30-day case fatality rate after first ischemic stroke ranges from 16 to 23 percent. Available data suggest that persistent neurologic deficits observed at six months after stroke include hemiparesis and cognitive deficits in 40 to 50 percent of patients, and hemianopia, aphasia, or sensory deficits in 15 to 20 percent. Disability outcomes at six months after stroke include depression, inability to walk unassisted, and social impairments in approximately 30 percent, and institutional care in approximately 25 percent. (See 'Morbidity and mortality' above.) Outcome predictors In the acute phase of stroke, the strongest predictors of outcome are stroke severity and patient age. Stroke severity can be judged clinically, based upon the degree of neurologic impairment (eg, altered mentation, language, behavior, visual field deficit, motor deficit), and the size and location of the infarction on neuroimaging with MRI or CT. Other important influences on stroke outcome include infarct location, ischemic stroke mechanism, comorbid conditions, epidemiologic factors, and complications of stroke. (See 'Major predictors' above.) Pace of recovery In the period from 12 hours to seven days after ischemic stroke onset, many patients who are without complications experience moderate but steady improvement in neurologic impairments. The greatest proportion of recovery occurs in the first three to six months after stroke, with lesser improvements thereafter. (See 'Predicting recovery' above.) Arm and hand function The return of arm and hand function after stroke is particularly important to a good functional recovery. Early active finger extension, grasp release, shoulder shrug, shoulder abduction, and active range of motion are associated with a favorable prognosis for arm and hand recovery at six months. (See 'Specific neurologic deficits' above.) ACKNOWLEDGMENT The UpToDate editorial staff acknowledges Alexander Dromerick, MD, who contributed to an earlier version of this topic review. Use of UpToDate is subject to the Terms of Use. https://www.uptodate.com/contents/overview-of-ischemic-stroke-prognosis-in-adults/print 15/43 7/6/23, 12:06 PM Overview of ischemic stroke prognosis in adults - UpToDate REFERENCES 1. Grysiewicz RA, Thomas K, Pandey DK. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin 2008; 26:871. 2. Feigin VL, Lawes CM, Bennett DA, Anderson CS. 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