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A clinical comparative analysis between expanded NIHSS and original NIHSS in posterior circulation ischemic stroke.

Tamer Roushdy1, Azza Abdel Nasser1, Ayman Nasef1

  • 1Neurology Department, Faculty of Medicine, Ain Shams University, Egypt.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|June 17, 2023
PubMed
Summary

The expanded NIHSS (e-NIHSS) is more sensitive than the standard NIHSS for detecting posterior circulation strokes. This enhanced stroke scale improves diagnosis and prognosis, showing greater clinical relevance.

Keywords:
A cutoff valueExpanded NIHSSNIHSSOutcomePosterior circulationStroke

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Clinical Assessment Tools

Background:

  • The National Institutes of Health Stroke Scale (NIHSS) is a standard tool but has limitations in detecting posterior circulation strokes.
  • The expanded NIHSS (e-NIHSS) was proposed in 2016 but has received limited attention.
  • This study evaluates the clinical utility of e-NIHSS compared to NIHSS for posterior circulation strokes.

Purpose of the Study:

  • To compare the scoring differences between e-NIHSS and NIHSS in posterior circulation strokes.
  • To assess the impact of scoring variations on patient management decisions.
  • To determine the prognostic value of baseline e-NIHSS for 90-day functional outcomes and identify optimal cutoff values.

Main Methods:

  • A longitudinal observational study was conducted on 79 patients with confirmed posterior circulation strokes.
  • Data collection included baseline and follow-up assessments using both NIHSS and e-NIHSS.
  • Statistical analysis and Receiver Operating Characteristic (ROC) curve analysis were performed to evaluate diagnostic and prognostic performance.

Main Results:

  • e-NIHSS scores were significantly higher than NIHSS scores at baseline, 24 hours, and discharge (P < 0.001).
  • A higher proportion of patients showed moderate/moderate-severe stroke severity with e-NIHSS.
  • e-NIHSS demonstrated greater sensitivity in prognosing less favorable 90-day functional outcomes (e-NIHSS > NIHSS).
  • ROC analysis indicated an e-NIHSS cutoff score of ≥8 with 82% sensitivity and 81% specificity.

Conclusions:

  • The expanded NIHSS (e-NIHSS) is a valuable diagnostic and prognostic tool for posterior circulation strokes.
  • e-NIHSS shows improved sensitivity and prognostic accuracy compared to the standard NIHSS.
  • Consideration of e-NIHSS in future clinical guidelines for stroke assessment is recommended.