NIHSS score and arteriographic findings in acute ischemic stroke

• Published in: Stroke (1970) 2005-10, Vol.36 (10), p.2121-2125
• Main Authors: FISCHER, Urs, ARNOLD, Marcel, NEDELTCHEV, Krassen, BREKENFELD, Caspar, BALLINARI, Pietro, REMONDA, Luca, SCHROTH, Gerhard, MATTLE, Heinrich P
• Format: Article
• Language: English
• Subjects: Aged; Angiography - methods; Angiography, Digital Subtraction - methods; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - diagnosis; Brain Ischemia - pathology; Carotid Arteries - pathology; Carotid Stenosis - diagnosis; Carotid Stenosis - pathology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - pathology; Male; Medical sciences; Middle Aged; Middle Cerebral Artery - pathology; Multivariate Analysis; Nervous system (semeiology, syndromes); Neurology; Odds Ratio; Pharmacology. Drug treatments; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Stroke - diagnosis; Stroke - pathology; Thrombolytic Therapy - methods; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000182099.04994.fc

To test the hypothesis that the National Institutes of Health Stroke Scale (NIHSS) score is associated with the findings of arteriography performed within the first hours after ischemic stroke. We analyzed NIHSS scores on hospital admission and clinical and arteriographic findings of 226 consecutive patients (94 women, 132 men; mean age 62+/-12 years) who underwent arteriography within 6 hours of symptom onset in carotid stroke and within 12 hours in vertebrobasilar stroke. From stroke onset to hospital admission, 155+/-97 minutes elapsed, and from stroke onset to arteriography 245+/-100 minutes elapsed. Median NIHSS was 14 (range 3 to 38), and scores differed depending on the arteriographic findings (P or =10 had positive predictive values (PPVs) to show arterial occlusions in 97% of carotid and 96% of vertebrobasilar strokes. With an NIHSS score of > or =12, PPV to find a central occlusion was 91%. In a multivariate analysis, NIHSS subitems such as "level of consciousness questions," "gaze," "motor leg," and "neglect" were predictors of central occlusions. There is a significant association of NIHSS scores and the presence and location of a vessel occlusion. With an NIHSS score > or =10, a vessel occlusion will likely be seen on arteriography, and with a score > or =12, its location will probably be central.