BACKGROUND AND PURPOSE: There is some controversy on the association of the National Institutes of Health Stroke Scale (NIHSS) score to predict arterial occlusion on MR arteriography and CT arteriography in acute stroke. METHODS: We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66 ± 14 years) with acute anterior or posterior circulation strokes. RESULTS: The study included 1603 patients examined with MR arteriography and 549 with CT arteriography. Of those, 1043 patients (48.5%; median NIHSS score 5, median time to clinical assessment 179 minutes) showed an occlusion, 887 in the anterior (median NIHSS score 7/0-31), and 156 in the posterior circulation (median NIHSS score 3/0-32). Eight hundred sixty visualized occlusions (82.5%) were located centrally (ie, in the basilar, intracranial vertebral, internal carotid artery, or M1/M2 segment of the middle cerebral artery). NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation. Best cut-off values within 3 hours after symptom onset were NIHSS scores ≥ 9 (positive predictive value 86.4%) and NIHSS scores ≥ 7 within >3 to 6 hours (positive predictive value 84.4%). Patients with central occlusions presenting within 3 hours had NIHSS scores <4 in only 5%. In the posterior circulation and in patients presenting after 6 hours, the predictive value of the NIHSS score for vessel occlusion was poor. CONCLUSIONS: There is a significant association of NIHSS scores and vessel occlusions in patients with anterior circulation strokes. This association is best within the first hours after symptom onset. Thereafter and in the posterior circulation the association is poor.
BACKGROUND AND PURPOSE: There is some controversy on the association of the National Institutes of Health Stroke Scale (NIHSS) score to predict arterial occlusion on MR arteriography and CT arteriography in acute stroke. METHODS: We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66 ± 14 years) with acute anterior or posterior circulation strokes. RESULTS: The study included 1603 patients examined with MR arteriography and 549 with CT arteriography. Of those, 1043 patients (48.5%; median NIHSS score 5, median time to clinical assessment 179 minutes) showed an occlusion, 887 in the anterior (median NIHSS score 7/0-31), and 156 in the posterior circulation (median NIHSS score 3/0-32). Eight hundred sixty visualized occlusions (82.5%) were located centrally (ie, in the basilar, intracranial vertebral, internal carotid artery, or M1/M2 segment of the middle cerebral artery). NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation. Best cut-off values within 3 hours after symptom onset were NIHSS scores ≥ 9 (positive predictive value 86.4%) and NIHSS scores ≥ 7 within >3 to 6 hours (positive predictive value 84.4%). Patients with central occlusions presenting within 3 hours had NIHSS scores <4 in only 5%. In the posterior circulation and in patients presenting after 6 hours, the predictive value of the NIHSS score for vessel occlusion was poor. CONCLUSIONS: There is a significant association of NIHSS scores and vessel occlusions in patients with anterior circulation strokes. This association is best within the first hours after symptom onset. Thereafter and in the posterior circulation the association is poor.
Authors: Brian S Katz; Opeolu Adeoye; Heidi Sucharew; Joseph P Broderick; Jason McMullan; Pooja Khatri; Michael Widener; Kathleen S Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Daniel Woo; Simona Ferioli; Jason Mackey; Sharyl Martini; Felipe De Los Rios la Rosa; Dawn O Kleindorfer Journal: Stroke Date: 2017-07-12 Impact factor: 7.914
Authors: Jens Fiehler; Christophe Cognard; Mauro Gallitelli; Olav Jansen; Adam Kobayashi; Heinrich P Mattle; Keith W Muir; Mikael Mazighi; Karl Schaller; Peter D Schellinger Journal: Eur Stroke J Date: 2016-07-26
Authors: Clinton D Morgan; Marcus Stephens; Scott L Zuckerman; Magarya S Waitara; Peter J Morone; Michael C Dewan; J Mocco Journal: Interv Neuroradiol Date: 2015-06-10 Impact factor: 1.610
Authors: Nitin Goyal; Georgios Tsivgoulis; Konark Malhotra; Muhammad F Ishfaq; Abhi Pandhi; Michael T Frohler; Alejandro M Spiotta; Mohammad Anadani; Marios Psychogios; Volker Maus; Adnan Siddiqui; Muhammad Waqas; Peter D Schellinger; Marcel Groen; Christos Krogias; Daniel Richter; Maher Saqqur; Pablo Garcia-Bermejo; Maxim Mokin; Ronen Leker; Jose E Cohen; Aristeidis H Katsanos; Georgios Magoufis; Klearchos Psychogios; Vasileios Lioutas; Meg VanNostrand; Vijay K Sharma; Maurizio Paciaroni; Alexandros Rentzos; Hazem Shoirah; J Mocco; Christopher Nickele; Violiza Inoa; Daniel Hoit; Lucas Elijovich; Andrei V Alexandrov; Adam S Arthur Journal: JAMA Neurol Date: 2020-01-01 Impact factor: 18.302