title: Zero on the NIHSS does not equal the absence of stroke.
abstract: OBJECTIVE
  The National Institutes of Health Stroke Scale (NIHSS) measures deficits caused by a stroke, but not all stroke signs are captured on the NIHSS. We determine the symptoms and stroke localization of patients with brain infarction and an NIHSS score of 0.
  
  
  METHODS
  We studied all patients who presented with acute neurologic symptoms to our stroke center from 2004 to 2008 and had persistent symptoms at the evaluation in the emergency department, an NIHSS score of 0, and an infarct on diffusion-weighted imaging. We characterized the symptoms, signs, lesion location, demographics, and stroke causes.
  
  
  RESULTS
  Twenty patients met inclusion criteria. Symptoms frequently experienced were headache, vertigo, and nausea. The posterior circulation was commonly infarcted in this group. Truncal ataxia was the most common neurologic sign.
  
  
  CONCLUSIONS
  Ischemic stroke may cause symptoms that are associated with no deficits on the NIHSS score.
authors.affiliation: Stroke Program at Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Jessica
authors.initials: J
authors.lastname: Tanksley
authors.forename: Vijay
authors.initials: V
authors.lastname: Pandav
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Jones
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: D001259:Ataxia / Q000209:etiology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D014717:Vertigo / Q000209:etiology