Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients

Area of Science:

• Neuroscience
• Neurology
• Medical Imaging

Background:

• Lesion-symptom mapping (LSM) traditionally uses total scores for stroke outcome analysis.
• The National Institutes of Health Stroke Scale (NIHSS) has 11 domains, and total scores may obscure specific structure-function relationships.
• Investigating sub-scores can provide a more nuanced understanding of neurological deficits post-stroke.

Purpose of the Study:

• To assess the feasibility of using NIHSS sub-scores for lesion-symptom mapping (LSM).
• To identify category-specific structure-function relationships not apparent with total NIHSS scores.
• To enhance predictive modeling of stroke outcomes through detailed LSM.

Main Methods:

• Multivariate lesion-symptom mapping (LSM) analyses were performed on 180 stroke patients from the ESCAPE trial.
• NIHSS domains were categorized into six groups using two distinct schemes.
• LSM was conducted for each sub-score category and the total NIHSS score.

Main Results:

• Sub-score LSM identified critical brain regions consistent with total score LSM.
• Additional brain regions critical to specific NIHSS function categories were revealed by sub-score LSM.
• These findings were achieved without requiring specialized clinical assessments.

Conclusions:

• Widely available NIHSS sub-scores can be utilized for detailed structure-function relationship investigations.
• This approach offers improved predictive modeling for stroke outcomes.
• The findings support the integration of sub-score LSM in clinical stroke assessments and neuroimaging.