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Published on: December 16, 2022
Baseline NIH stroke scale responses estimate the probability of each particular stroke subtype
E C Leira1, H P Adams, G E Rosenthal
1Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA. enrique-leira@uiowa.edu
Cerebrovascular Diseases (Basel, Switzerland)
|October 24, 2008
Summary
Baseline National Institutes of Health Stroke Scale (NIHSS) items can help identify ischemic stroke subtypes. Specific NIHSS scores can predict the likelihood of lacunar versus nonlacunar strokes, aiding emergency treatment decisions.
Area of Science:
- Neurology
- Clinical Medicine
- Stroke Research
Background:
- Accurate and rapid diagnosis of ischemic stroke subtypes is crucial for effective, mechanism-specific emergency treatment.
- Current diagnostic methods for acute stroke subtypes present challenges in emergency settings.
- Neurological deficit patterns often correlate with specific stroke subtypes, suggesting potential diagnostic markers.
Purpose of the Study:
- To investigate whether scores on baseline National Institutes of Health Stroke Scale (NIHSS) items can predict the probability of specific ischemic stroke subtypes.
- To determine if specific NIHSS items or their combinations can aid in the emergent stratification of stroke patients.
Main Methods:
- Multivariate polytomous logistic regression analyses were conducted on 1,281 patients from the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) cohort.
- The predictive value of individual NIHSS items and syndromic combinations was assessed for anticipating TOAST stroke subtypes at 3 months, adjusting for atrial fibrillation.
- A predictive model was constructed using the most significant NIHSS items identified.
Main Results:
- Language, neglect, visual field deficits, and brachial predominance of weakness on the NIHSS were significant discriminators of stroke subtypes.
- In patients without atrial fibrillation, a normal score on these four variables indicated a higher likelihood of lacunar stroke (46%) compared to atherothrombotic (12%) or cardioembolic (10%) stroke.
- Conversely, abnormalities in all four NIHSS items shifted the probabilities towards atherothrombotic (50%) and cardioembolic (39%) stroke, with a low probability of lacunar stroke (0.1%).
Conclusions:
- Baseline NIHSS items, specifically language, neglect, visual fields, and brachial weakness patterns, effectively differentiate between ischemic stroke subtypes, particularly lacunar versus nonlacunar strokes.
- These findings suggest that NIHSS items can be utilized for emergent patient stratification in clinical trials targeting specific stroke mechanisms.
- The study provides a validated method for improving the speed and accuracy of stroke subtype diagnosis in emergency care.
