National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke
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. We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66 ± 14 ye...
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| Veröffentlicht in: | Stroke (1970) 2013-04, Vol.44 (4), p.1153-1157 |
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| creator | HELDNER, Mirjam R ZUBLER, Christoph XIN YAN ARNOLD, Marcel OZDOBA, Christoph MORDASINI, Pasquale FISCHER, Urs MATTLE, Heinrich P SCHROTH, Gerhard WECK, Anja MONO, Marie-Luise GRALLA, Jan JUNG, Simon EL-KOUSSY, Marwan LÜDI, Rudolf |
| description | 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.
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.
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 |
| doi_str_mv | 10.1161/STROKEAHA.111.000604 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.111.000604</identifier><identifier>PMID: 23471266</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Angiography - methods ; Arterial Occlusive Diseases - diagnosis ; Arterial Occlusive Diseases - diagnostic imaging ; Biological and medical sciences ; Brain Ischemia - diagnosis ; Brain Ischemia - pathology ; Carotid Artery, Internal - pathology ; Female ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Magnetic Resonance Angiography - methods ; Male ; Medical sciences ; Middle Aged ; Middle Cerebral Artery - pathology ; National Institutes of Health (U.S.) ; Nervous system (semeiology, syndromes) ; Neurology ; Severity of Illness Index ; Stroke - diagnosis ; Stroke - pathology ; Time Factors ; Tomography, X-Ray Computed - methods ; United States ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2013-04, Vol.44 (4), p.1153-1157</ispartof><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-f548ce7a32946336c3f0edf6c9c4769eeb50a28f5c7b3f771651a2a8544184d73</citedby><cites>FETCH-LOGICAL-c434t-f548ce7a32946336c3f0edf6c9c4769eeb50a28f5c7b3f771651a2a8544184d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3685,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27383005$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23471266$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HELDNER, Mirjam R</creatorcontrib><creatorcontrib>ZUBLER, Christoph</creatorcontrib><creatorcontrib>XIN YAN</creatorcontrib><creatorcontrib>ARNOLD, Marcel</creatorcontrib><creatorcontrib>OZDOBA, Christoph</creatorcontrib><creatorcontrib>MORDASINI, Pasquale</creatorcontrib><creatorcontrib>FISCHER, Urs</creatorcontrib><creatorcontrib>MATTLE, Heinrich P</creatorcontrib><creatorcontrib>SCHROTH, Gerhard</creatorcontrib><creatorcontrib>WECK, Anja</creatorcontrib><creatorcontrib>MONO, Marie-Luise</creatorcontrib><creatorcontrib>GRALLA, Jan</creatorcontrib><creatorcontrib>JUNG, Simon</creatorcontrib><creatorcontrib>EL-KOUSSY, Marwan</creatorcontrib><creatorcontrib>LÜDI, Rudolf</creatorcontrib><title>National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>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.
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.
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.
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.</description><subject>Aged</subject><subject>Angiography - methods</subject><subject>Arterial Occlusive Diseases - diagnosis</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - pathology</subject><subject>Carotid Artery, Internal - pathology</subject><subject>Female</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery - pathology</subject><subject>National Institutes of Health (U.S.)</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Severity of Illness Index</subject><subject>Stroke - diagnosis</subject><subject>Stroke - pathology</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>United States</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1Lw0AQhhdRbK3-A5G9CF6i-5XN5liK2mKxYqsew3Y7i9E0aTObg__elVa9zDDwvO_AQ8g5Z9eca34zXzzPHm6H42E8-TVjTDN1QPo8FSpRWphD0mdM5olQed4jJ4gfkRHSpMekJ6TKuNC6T7aPNpRNbSs6qTGUoQuAtPF0DLYK73Qe2uYT6NzZ6mc2LVBbr-grIEJFZ85VHcY4LWsq4mf6FNugDkjfypgeulhHJ-jeYV26fdkpOfK2Qjjb7wF5ubtdjMbJdHY_GQ2niVNShcSnyjjIrBS50lJqJz2DldcudyrTOcAyZVYYn7psKX2WcZ1yK6xJleJGrTI5IFe73k3bbDvAUKxLdFBVtoamw4JLwbhWhpmIqh3q2gaxBV9s2nJt26-Cs-JHdvEnO5682MmOsYv9h265htVf6NduBC73gMVo0Le2diX-c5k0krFUfgNKI4c2</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>HELDNER, Mirjam R</creator><creator>ZUBLER, Christoph</creator><creator>XIN YAN</creator><creator>ARNOLD, Marcel</creator><creator>OZDOBA, Christoph</creator><creator>MORDASINI, Pasquale</creator><creator>FISCHER, Urs</creator><creator>MATTLE, Heinrich P</creator><creator>SCHROTH, Gerhard</creator><creator>WECK, Anja</creator><creator>MONO, Marie-Luise</creator><creator>GRALLA, Jan</creator><creator>JUNG, Simon</creator><creator>EL-KOUSSY, Marwan</creator><creator>LÜDI, Rudolf</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke</title><author>HELDNER, Mirjam R ; ZUBLER, Christoph ; XIN YAN ; ARNOLD, Marcel ; OZDOBA, Christoph ; MORDASINI, Pasquale ; FISCHER, Urs ; MATTLE, Heinrich P ; SCHROTH, Gerhard ; WECK, Anja ; MONO, Marie-Luise ; GRALLA, Jan ; JUNG, Simon ; EL-KOUSSY, Marwan ; LÜDI, Rudolf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-f548ce7a32946336c3f0edf6c9c4769eeb50a28f5c7b3f771651a2a8544184d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Angiography - methods</topic><topic>Arterial Occlusive Diseases - diagnosis</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Biological and medical sciences</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - pathology</topic><topic>Carotid Artery, Internal - pathology</topic><topic>Female</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery - pathology</topic><topic>National Institutes of Health (U.S.)</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Severity of Illness Index</topic><topic>Stroke - diagnosis</topic><topic>Stroke - pathology</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>United States</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HELDNER, Mirjam R</creatorcontrib><creatorcontrib>ZUBLER, Christoph</creatorcontrib><creatorcontrib>XIN YAN</creatorcontrib><creatorcontrib>ARNOLD, Marcel</creatorcontrib><creatorcontrib>OZDOBA, Christoph</creatorcontrib><creatorcontrib>MORDASINI, Pasquale</creatorcontrib><creatorcontrib>FISCHER, Urs</creatorcontrib><creatorcontrib>MATTLE, Heinrich P</creatorcontrib><creatorcontrib>SCHROTH, Gerhard</creatorcontrib><creatorcontrib>WECK, Anja</creatorcontrib><creatorcontrib>MONO, Marie-Luise</creatorcontrib><creatorcontrib>GRALLA, Jan</creatorcontrib><creatorcontrib>JUNG, Simon</creatorcontrib><creatorcontrib>EL-KOUSSY, Marwan</creatorcontrib><creatorcontrib>LÜDI, Rudolf</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HELDNER, Mirjam R</au><au>ZUBLER, Christoph</au><au>XIN YAN</au><au>ARNOLD, Marcel</au><au>OZDOBA, Christoph</au><au>MORDASINI, Pasquale</au><au>FISCHER, Urs</au><au>MATTLE, Heinrich P</au><au>SCHROTH, Gerhard</au><au>WECK, Anja</au><au>MONO, Marie-Luise</au><au>GRALLA, Jan</au><au>JUNG, Simon</au><au>EL-KOUSSY, Marwan</au><au>LÜDI, Rudolf</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>44</volume><issue>4</issue><spage>1153</spage><epage>1157</epage><pages>1153-1157</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>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.
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.
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.
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>23471266</pmid><doi>10.1161/STROKEAHA.111.000604</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Stroke (1970), 2013-04, Vol.44 (4), p.1153-1157 |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete - AutoHoldings; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Angiography - methods Arterial Occlusive Diseases - diagnosis Arterial Occlusive Diseases - diagnostic imaging Biological and medical sciences Brain Ischemia - diagnosis Brain Ischemia - pathology Carotid Artery, Internal - pathology Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Magnetic Resonance Angiography - methods Male Medical sciences Middle Aged Middle Cerebral Artery - pathology National Institutes of Health (U.S.) Nervous system (semeiology, syndromes) Neurology Severity of Illness Index Stroke - diagnosis Stroke - pathology Time Factors Tomography, X-Ray Computed - methods United States Vascular diseases and vascular malformations of the nervous system |
| title | National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic Stroke |
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