Abstract 145: Outcome in Patients with Minor Stroke: The Effect of Itemized NIHSS Score Subsets

Background: The use of the National Insitutes of Health Stroke Scale (NIHSS) to assess stroke severity in minor stroke is controversial. We hypothesized that patients with cortical signs on the itemized NIHSS subsets (neglect, visual, or language) will have a worse outcome than those without. Methods: Data was retrieved from the Columbia SPOTRIAS dataset. All patients with NIHSS between 0 and 5 within 12 hours from symptom onset who were not treated with intravenous thrombolysis were included. Patients were followed prospectively as part of the “Stroke Warning Information and Faster Treatment” Study. Poor outcome was defined as not being discharged home and analyzed using multivariable logistic regression. The primary predictor was cortical features on the itemized NIHSS. Individual components of the NIHSS score, treated as a dichotomous variable, as well as the admission NIHSS score were assessed in secondary analyses. Results: The sample included 894 patients, of which 162 (18%) were not discharged home. In multivariable regression analysis of baseline demographics, risk factors, median NIHSS, and cortical signs, only mean age (OR = 1.02, P<0.001) and NIHSS score (OR = 1.59, p<0.001) were associated with non-discharge home. In secondary analyses having any score on the following items predicted non-discharge home: Motor (OR = 2.40, p<0.001), LOC (OR = 6.67, p=0.004), and Ataxia (OR = 3.21, p<0.001). Other items from the NIHSS were not associated with discharge disposition. Motor deficits (AUC 0.623) appeared to be more predictive of discharge outcome than ataxia (AUC 0.569) and LOC deficits (AUC 0.517). In addition, the admission NIHSS had a fair correlation with discharge outcome (AUC 0.683). Conclusion: Deficits in LOC, motor weakness, and ataxia predict discharge outcome in patients with mild stroke, with the motor score being the most influential component. This may potentially alter treatment decisions in this population. The fair correlation between NIHSS score and discharge outcome suggests that certain factors not captured by the NIHSS score may contribute to discharge outcome in this patient population.

Download Full-text

The Itemized NIHSS Scores Are Associated With Discharge Disposition in Patients With Minor Stroke

The Neurohospitalist ◽

10.1177/1941874416641466 ◽

2016 ◽

Vol 6 (3) ◽

pp. 102-106 ◽

Cited By ~ 8

Author(s):

Shadi Yaghi ◽

Joshua Z. Willey ◽

Howard Andrews ◽

Amelia K. Boehme ◽

Randolph S. Marshall ◽

...

Keyword(s):

Area Under The Curve ◽

Final Diagnosis ◽

Minor Stroke ◽

Stroke Severity ◽

Nihss Score ◽

Discharge Disposition ◽

Poor Outcome ◽

Level Of Consciousness ◽

Unit Increase ◽

Multivariable Regression

Background and purpose: The ability of the National Institutes of Health Stroke Scale (NIHSS) score to predict functional outcome in minor stroke is controversial. In this study, we examined the association of itemized NIHSS score with discharge outcome. Methods: We included all patients with final diagnosis of stroke with an NIHSS score of 0 to 5 untreated with thrombolysis enrolled in the “Stroke Warning Information and Faster Treatment” trial. Individual components of the NIHSS score were the primary predictors. Poor outcome was defined as not being discharged home. Logistic regression was used to identify predictors of outcome. Results: A total of 861 patients met the inclusion criteria; 162 (19%) were not discharged home. In multivariable regression, predictors of discharge other than home were age (odds ratio [OR] = 1.02 per year increase, P < .001) and total NIHSS score (OR per unit increase in the NIHSS = 1.51, P < .001). Motor (OR = 2.32, P < .001), level of consciousness (LOC; OR = 6.62, P = .004), and ataxia (OR = 3.10, P < .001) were also associated with not being discharged home. Motor (area under the curve [AUC] 0.623) appeared to be more predictive of poor outcome than ataxia (AUC 0.569) and LOC (AUC 0.517). The total NIHSS had a fair correlation with discharge outcome (AUC 0.683). Conclusion: Total and itemized NIHSS components have a fair correlation with outcome in minor stroke highlighting the importance of other measures of stroke severity for clinical trials.

Download Full-text

Abstract P274: Evaluation of Glycemic Variability and Discharge Outcomes in Patients Presenting With Ischemic Stroke Following Intravenous Thrombolysis

Stroke ◽

10.1161/str.52.suppl_1.p274 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mackenzie Steck ◽

Omar Saeed ◽

Balaji Krishnaiah ◽

Samarth Shah ◽

Jaclyn Stoffel ◽

...

Keyword(s):

Ischemic Stroke ◽

Statistical Significance ◽

Univariate Analysis ◽

Intravenous Thrombolysis ◽

Glycemic Variability ◽

P Value ◽

Nihss Score ◽

Discharge Disposition ◽

Discharge Outcomes

Presentation Objective: Does glycemic variability worsen Modified Rankin Score (mRS) following ischemic stroke in patients treated with thrombolytics (tPA)? Background/Purpose: Acute hyperglycemia and strict glucose control have been identified as predictors of hemorrhage, increased length of stay and hypoglycemia following ischemic stroke. However, the role of glucose variability in patients with ischemic stroke treated with tPA is largely unknown. The aim of this study was to evaluate the role of glycemic variability on discharge outcomes in patients treated with tPA for ischemic stroke. Methodology: A retrospective review of adults with ischemic stroke who received tPA was completed. Patients hospitalized for at least 48 hours with image-confirmed ischemic stroke and symptom onset within 4.5 hours of presentation were included. Glycemic variability was measured using the J-index calculation and groups were defined as patients with normal or abnormal J-indices. Logistic regression models were developed to determine odds ratios for defined outcomes including NIHSS score, mRS and disposition at discharge. Statistical significance was a p-value of <0.05. Results: Of the 229 patients included, 132 (58%) had a normal J-index (4.7 – 23.6). In the univariate analysis, abnormal J-index was associated with higher rates of hypertension (94% vs 73%), type 2 diabetes mellitus (74% vs 12%), chronic kidney disease (34% vs 11%), higher initial blood glucose values (220 ±172 vs 111 ±20) and HbA1c, and worse outcomes in terms of NIHSS score, mRS and disposition at discharge. In the multivariate analysis, patients with an abnormal J-index had higher odds of unfavorable outcomes in terms of discharge mRS (OR 2.1; 95% CI 1.0 – 4.3, p=0.045) and hemorrhagic transformation (OR 4.1; 95% CI 1.7 – 10.2, p=0.002). There was no difference in discharge disposition (OR 1.4; 95% CI 0.7 – 3.0 p=0.4). Conclusion: Glycemic variability, following ischemic stroke, may result in unfavorable patient outcomes in patients treated with tPA. Additional studies are needed to determine the appropriate glucose management strategy.

Download Full-text

Historic Stroke Motor Severity Score Predicts Progression in TIA/Minor Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100016206 ◽

2014 ◽

Vol 41 (1) ◽

pp. 19-23 ◽

Cited By ~ 3

Author(s):

Marie-Christine Camden ◽

Michael D. Hill ◽

Andrew M. Demchuk ◽

Alexandre Y. Poppe ◽

Nan Shobha ◽

...

Keyword(s):

Severity Score ◽

Recurrent Stroke ◽

Minor Stroke ◽

Motor Deficits ◽

Stroke Severity ◽

Early Improvement ◽

Stroke Population ◽

Early Neurological Deterioration ◽

Ischemic Attack ◽

Symptom Progression

Background:transient ischemic attack (tIA) and minor stroke have a high risk of early neurological deterioration, and patients who experience early improvement are at risk of deterioration. We generated a score for quantifying the worst reported motor and speech deficits and assessed whether this predicted outcome.Methods:510 tIA or minor stroke (NIHSS>4) patients were included. the Historical Stroke Severity Score (HSSS) prospectively quantified the patient's description of the worst motor or speech deficits. the HSSS was rated at the time of first assessment with more severe deficits scoring higher. Motor HSSS included assessments of arm and leg motor power (score total 0-5). Speech HSSS assessed severity of dysarthria and aphasia (total 0-3). the association between motor and speech HSSS and symptom progression was assessed during the 90-day follow-up period.Results:the proportion of patients in each category of the motor HSSS was 0: 43% (216/510), 1: 22%(110/510), 2: 17% (89/510), 3: 7% (37/510), 4: 5% (28/510) and 5: 6% (30/510). Motor HSSS was associated with symptom progression (p=0.004) but not recurrent stroke. Speech HSSS was not associated with either progression or recurrent stroke. Motor HSSS predicted disability (p=0.002) and intracranial occlusion (p=0.012). Disability increased with increasing motor HSSS.Conclusions:taking a detailed history about the severity of motor deficits, but not speech, predicted outcome in tIA and minor stroke patients. A score based on the patient's description of the severity of motor symptoms predicted symptom progression, intracranial occlusion and functional outcome, but not recurrent stroke in a tIA and minor stroke population.

Download Full-text

Abstract 75: Safety of Statin Pretreatment in Intravenous Thrombolysis (IVT) for Acute Ischemic Stroke (AIS)

Stroke ◽

10.1161/str.45.suppl_1.75 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Georgios Tsivgoulis ◽

Pavla Kadlecová ◽

Anna Czlonkowska ◽

Miroslav Brozman ◽

Victor Švigelj ◽

...

Keyword(s):

Symptom Onset ◽

Treatment Time ◽

Meta Analysis ◽

Time History ◽

Intravenous Thrombolysis ◽

Statin Treatment ◽

Adverse Outcomes ◽

Stroke Severity ◽

Nihss Score ◽

Increased Risk

Background&Purpose: A recent meta-analysis investigating the association between statin pretreatment and early outcomes in patients with AIS indicated that pre-stroke statin treatment was associated with increased risk of 90-day mortality and symptomatic intracranial hemorrhage (sICH). We sought to investigate the potential association of statin pretreatment with early outcomes in a large, international registry of AIS patients treated with IVT. Subjects&Methods: We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke-East registry (SITS-EAST) on consecutive AIS patients treated with IVT during a seven-year period. We used three widely accepted definitions for sICH from NINDS-rtPA-Stroke Study, ECASS II trial and SITS registry. Dramatic clinical recovery (DCR) within 24 hours was defined as reduction in the baseline NIHSS-score of ≥10 points. Favorable functional outcome (FFO) at three months was defined as modified Rankin Scale score of 0-1. Results: We analyzed a total of 1660 AIS patients (mean age 67±13 years, median baseline NIHSS-score 11 points, interquartile range 5-16). Patients with statin pretreatment (n=373, 23%) had higher (p=0.019) baseline stroke severity compared to cases who had not received any statin at symptom onset. After adjusting for demographics, baseline stroke severity, onset-to-treatment time, history of previous stroke, risk factors, and admission blood pressure levels, statin pretreatment was not associated with a higher likelihood of sICH defined by the NINDS (OR: 1.41; 95%CI: 0.83-2.39; p=0.201), ECASS II (OR: 1.13; 95%CI: 0.60-2.14; p=0.712) or SITS (OR: 1.89; 95%CI: 0.75-4.77; p=0.178) criteria. Statin pretreatment was not related to three-month all-cause mortality (OR: 0.92; 95%CI: 0.57-1.49; p=0.741) or three-month FFO (OR: 0.81; 95%CI: 0.52-1.27; p=0.364). Statin pretreatment was independently associated with a higher odds of DCR (OR: 1.91; 95%CI: 1.25-2.92; p=0.003). Conclusions: Our findings indicate that statin therapy at symptom onset is not associated with adverse outcomes in AIS patients treated with IVT, while statin pretreatment almost doubles the likelihood of DCR during the first hours following tPA-infusion.

Download Full-text

Delayed Intravenous Thrombolysis in Patients with Minor Stroke

Cerebrovascular Diseases ◽

10.1159/000492123 ◽

2018 ◽

Vol 46 (1-2) ◽

pp. 52-58 ◽

Cited By ~ 4

Author(s):

Joonsang Yoo ◽

Sung-Il Sohn ◽

Jinkwon Kim ◽

Seong Hwan Ahn ◽

Kijeong Lee ◽

...

Keyword(s):

Intravenous Thrombolysis ◽

Stroke Care ◽

Minor Stroke ◽

Acute Stroke Care ◽

Nihss Score ◽

Delayed Treatment ◽

Intravenous Tissue Plasminogen Activator ◽

Stroke Group ◽

Suspected Stroke ◽

Iv Tpa

Background: The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). Methods: We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score < 5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time > 40 min. Results: During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], p < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], p < 0.001) and door-to-imaging time (20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], p < 0.001) than did the non-minor stroke group. However, the imaging-to-needle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], p = 0.001). Conclusions: Our findings show that the door-to-needle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.

Download Full-text

Initial Stroke Severity Is the Major Outcome Predictor for Patients Who Do Not Receive Intravenous Thrombolysis due to Mild or Rapidly Improving Symptoms

ISRN Neurology ◽

10.5402/2011/947476 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Mu-Chien Sun ◽

Tien-Bao Lai

Keyword(s):

Independent Predictor ◽

Intravenous Thrombolysis ◽

National Institutes Of Health ◽

Unfavorable Outcome ◽

Stroke Severity ◽

Outcome Predictor ◽

Nihss Score ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Favorable Group

Intravenous tissue plasminogen activator thrombolysis for stroke is still under use. A substantial proportion of excluded patients for mild or improving symptoms are dependent at discharge. We prospectively recruited 49 patients who did not receive thrombolysis because of mild or improving symptoms. 32 had favorable outcome (mRS ≤ 2) and 17 had unfavorable outcome (mRS > 2) at discharge. Comparisons were made between the two groups. Age was older (72.5 ± 10.0 versus 64.7 ± 13.2 years, P = 0.037), and initial National Institutes of Health Stroke Scale (NIHSS) score (5.7 ± 4.0 versus 2.2 ± 2.1, P < 0.001) was higher in the unfavorable group. Diastolic blood pressure was higher in the favorable group (98 ± 15 versus 86 ± 18 mmHg; P = 0.018). Atrial fibrillation (3.1 versus 23.5%; P = 0.043) and ipsilateral artery stenosis (21.9 versus 58.8%; P = 0.012) were more frequently found in the unfavorable group. Percentage of patients excluded from thrombolysis due to improving symptoms was higher in the unfavorable group (40.6 versus 82.4%; P = 0.005). Initial NIHSS score, but not other factors, was identified by logistic regression analysis as a major independent predictor for unfavorable outcome (OR 1.44; 95%CI, 1.03–2.02).

Download Full-text

Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke

PLoS ONE ◽

10.1371/journal.pone.0251077 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0251077

Author(s):

Hung-Ming Wu ◽

I-Hui Lee ◽

Chao-Bao Luo ◽

Chih-Ping Chung ◽

Yung-Yang Lin

Keyword(s):

Thrombolytic Therapy ◽

Intravenous Thrombolysis ◽

Incidence Rates ◽

Favorable Outcome ◽

Stroke Severity ◽

Lesion Volume ◽

Nihss Score ◽

Neurological Improvement ◽

Early Neurological Deterioration ◽

Reliable Marker

Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. Methods Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admission NIHSS—baseline NIHSS score), symptomatic intracranial hemorrhage (sICH), mortality, and favorable outcome at 3 months. Results Patients in the P group had a greater proportion of favorable outcome at 3 months (p = 0.032) and more frequent ENI (p = 0.038) and a greater delta NIHSS score (p = 0.001), as well as a lower proportion of END (p = 0.004) than those in the N group patients. There were no significant differences in the incidence rates of sICH and mortality between the two groups. Conclusions Clinical-CT mismatch may be able to predict which patients would benefit from intravenous thrombolysis.

Download Full-text

Intravenous Thrombolysis for Acute Ischaemic Stroke in Young Adult Patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710012027x ◽

2009 ◽

Vol 36 (2) ◽

pp. 161-167 ◽

Cited By ~ 5

Author(s):

Alexandre Y. Poppe ◽

Alastair M. Buchan ◽

Michael D. Hill

Keyword(s):

Intravenous Thrombolysis ◽

Favourable Outcome ◽

Adult Patients ◽

Nihss Score ◽

Risk Of Death ◽

Intravenous Tissue Plasminogen Activator ◽

Lower Baseline ◽

Current Cigarette ◽

Multivariable Regression ◽

Iv Tpa

Background:Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients ≤50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population.Methods:Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged ≤50 years-old (n=99) were compared with those aged >50 years (n=1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death.Results:Nine percent of patients were ≤50 years-old. Among patients aged ≤50 years, 40.4% were women and median age was 42 ± 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p<0.05) and their baseline median NIHSS score was lower (13 versus 15, P=0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age ≤50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH.Conclusions:Adult patients ≤50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age ≤50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH.

Download Full-text

Abstract TP75: Creatinine on Admission Interacts with Intravenous Thrombolysis and Thrombectomy Procedures in Predicting Post-stroke Outcomes

Stroke ◽

10.1161/str.48.suppl_1.tp75 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nada El Husseini ◽

Cintasha Redmond ◽

Seung-Jae Lee ◽

Ralph B D’Agostino ◽

Cheryl Bushnell

Keyword(s):

Functional Outcome ◽

Tertiary Care ◽

Intravenous Thrombolysis ◽

Stroke Outcomes ◽

Lower Odds ◽

Post Stroke ◽

Discharge Disposition ◽

Discharge Home ◽

History Of ◽

Iv Tpa

Background: Renal impairment may be associated with reduced efficacy of thrombolysis, increased hemorrhagic complications and risk of contrast-induced nephropathy associated with catheter angiogram used in thrombectomies. It is unclear if creatinine interacts with IV-tpa and thrombectomy in predicting post stroke outcomes. Methods: This is a retrospective analysis of consecutive patients admitted with acute ischemic stroke to a single tertiary care center between October 2012 and July 2015. Logistic regression analysis was used to evaluate whether there was a differential impact of the association of IV-tpa and/or thrombectomy with discharge disposition (discharge home vs. other) and 3 months functional outcome (modified Rankin Score mRS<3 vs. mRS≥3) based on the admission creatinine (Cr) level (<1.5 and ≥1.5) after adjusting for sex, age, race, NIHSS on admission, history of atrial fibrillation and history of stroke/TIA. Results: A total of 570 subjects were included (48.6% male, 69.4% white, mean age 67years, mean NIHSS 7.1, mean Cr. 1.17 , 13.1% with Cr≥1.5). A total of 18.4% (N=105) received IV-tpa and an additional 6.5%(N=37) received thrombectomy in addition to IV-tpa. About 57% were discharged home and 46% had mRS<3 at 3 months. The mean NIHSS on admission was not significantly different based on creatinine level (7.0 vs.8.1, p=0.271 in subjects with Cr<1.5 and Cr≥1.5 respectively). After adjusting for other relevant variables, the interaction of creatinine with IV-tpa with/without thombectomy was significant in predicting both discharge home (p= 0.0009) and 3 months mRS (p=0.0063). In those with creatinine <1.5, IV-tpa with/without thrombectomy was associated with increased odds of being discharged home (OR=2.81, 95%CI 1.55-5.08), p=0.0006) and a good functional outcome (mRS<3 at 3 months) (OR= 2.91, 1.66-5.10), P=0.0002. In contrast, in those with Cr ≥1.5, IV tpa with/without thrombolysis was associated with lower odds of being discharged home (OR= 0.11; 95% CI 0.01-0.74), p=0.023 and lower odds of having a favorable 3 months functional outcome (mRS<3) (OR= 0.06; 95% CI 0.006-0.80), p=0.033. Conclusions: Creatinine on admission modified the effect of IV-tpa and thrombectomy. Reasons for this interaction warrant further investigation.

Download Full-text

Abstract W P26: Itemized NIHSS Subsets Predict MRI Positive Strokes In Patients With Mild Deficits

Stroke ◽

10.1161/str.46.suppl_1.wp26 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Charlotte Herber ◽

Joshua Z Willey ◽

Howard Andrews ◽

Randolph S Marshall ◽

...

Keyword(s):

Visual Field ◽

Infarct Volume ◽

Final Diagnosis ◽

Motor Deficits ◽

Lesion Volume ◽

Nihss Score ◽

Visual Deficits ◽

Multivariable Regression ◽

The Mean ◽

Attending Physician

Background: While imaging is useful in confirming the diagnosis of ischemic stroke, negative diffusion weighted imaging (DWI) is reported in up to 10% of patients. We aim to (1) identify predictors of MRI-positive stroke from the itemized NIHSS, and (2) to correlate subsets with infarct volume. Methods: Data were derived from the Stroke Warning Information and Faster Treatment study from 2006 to 2009 among patients with mild deficits (NIHSS 0-5) and attending physician final diagnosis of stroke. Using Medical Image Processing, Analysis, and Visualization (MIPAV, NIH) (Version 7.1.1), we calculated lesion volume (cm3) from DWI sequence. Univariate models studied the association between itemized NIHSS subsets, including cortical deficits (visual field cut, aphasia, or neglect), and presence of DWI hyperintensity and lesion volume. Multivariable regression assessed factors predicting DWI-positive strokes; p<0.05 was considered significant. Results: Of 611 patients with a discharge diagnosis of stroke, 498 underwent MRI and 29.5% were DWI negative. On multivariate analysis, predictors of a positive DWI were NIHSS score of 3-5 (OR= 2.5, 95%CI:1.1-5.5), motor deficits (OR= 1.9, 95%CI:1.1-3.4), and ataxia (OR=3.0, CI:1.5-6.1). All patients with neglect and visual deficits were DWI positive (table). The mean lesion volume in cm3 was larger in patients with NIHSS 3-5 vs. NHSS 0-2 (49.0 vs. 17.3, p=0.002), cortical deficits (112.6 vs. 22.9, p<0.001), neglect (236.6 vs. 29.7, p<0.001), and visual deficits (245.7 vs. 26.4, p<0.001). Other subsets showed no differences. Conclusion: NIHSS score subsets predict DWI positivity and lesion volume in mild strokes. The presence of neglect or visual field deficit on the NIHSS subsets is highly likely to have an MRI correlate even in patients with low NIHSS.

Download Full-text