A Simple Sign Showing Stroke Severity?

A German neurologist and his colleagues at a Munich hospital noticed that some of their patients with severe stroke could cross their legs soon after their stroke, while others could not; this was unrelated to their level of consciousness, paralysis of the crossed leg, or the need for ventilation or circulatory support.  They decided to investigate the prognostic value of this effect.  The results of their study are reported in the journal Neurology.

Patients with a severe stroke who crossed their legs during their hospital stay and matched them with randomly-selected severe stroke patients who did not cross their legs. All the patients were evaluated on admission, on the day of leg crossing, on discharge, and one year after discharge.  Four well-recognized scales of stroke severity were obtained at these time points.

There were 34 patients who crossed their legs and 34 matched controls; the two groups did not differ in any of the severity scales on admission.  At the time of discharge exams, 3 of the 4 scales were ‘better’ in favor of the leg-crossers, and one didn’t differ.  And at the 1-year follow-up, 2 of the 4 were significantly better in the leg-crosser group.  By this time, only one of the leg-crossing group had died, compared with 18 of the non-crossing controls – a highly significant statistical difference.    

The investigators point out that leg crossing is an easily-observed clinical sign, which is independent of more technical tests. Leg crossing within the first 15 days after a severe stroke suggests there will be a more favorable outcome: less neurological deficit, better chance of independence in daily living, and a lower chance of death.

It’s fascinating to think that this clinical sign hasn’t been observed before.  And it shows that clinical observation (both by physicians and the nursing staff) has a lot to offer in these days of imaging and machines.