title: Association of laterality and size of perfusion lesions on neurological deficit in acute supratentorial stroke.
abstract: BACKGROUND
  The influence of lesion size and laterality on each component of the National Institutes of Health Stroke Scale has not been delineated. The objective of this study was to use perfusion-weighted imaging to characterize the association of ischaemic volume and laterality on each component item and the total score of the <National Institutes of Health Stroke Scale.
  
  
  METHODS
  We analysed consecutive right-handed patients with first-ever supratentorial acute ischaemic strokes who underwent acute perfusion-weighted imaging at a single centre. Perfusion deficits were defined as mean transit time > 10 s. Ordinal regression was used to clarify the relationship between ischaemic volume, laterality, and <National Institutes of Health Stroke Scale scores.
  
  
  RESULTS
  Among 111 patients, 58 were left-hemisphere stroke, and 53 right-hemisphere stroke. Median ischaemic volume was 53 ml in left-hand stroke and 65 ml in right-hand stroke and median total National Institutes of Health Stroke Scale was 10 in left-hand stroke and eight in right-hand stroke. For individual National Institutes of Health Stroke Scale items, ischaemic volume correlated most closely with commands and visual field and most weakly with ataxia and neglect. Left-hand stroke predicted higher scores of total National Institutes of Health Stroke Scale and National Institutes of Health Stroke Scale items of questions, commands, right limb weakness, and language. Right-hand stroke predicted higher scores of left limb weakness and extinction.
  
  
  CONCLUSIONS
  Larger perfusion defects contribute to higher scores on the total and most individual items of the National Institutes of Health Stroke Scale. However, lesion laterality contributes substantially to half the item scores, with greater association of left than right-brain side. These findings indicate that imaging-deficit correlations will be improved by designating lesions into an atlas, taking into account side in addition to size.
authors.affiliation: Stroke Center and Department of Neurology, University of California, Los Angeles, CA, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Alger
authors.forename: Qing
authors.initials: Q
authors.lastname: Hao
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Doojin
authors.initials: D
authors.lastname: Kim
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Villablanca
authors.forename: Michael T
authors.initials: MT
authors.lastname: Froehler
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Tenser
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D011596:Psychomotor Disorders / Q000209:etiology / Q000473:pathology; D020521:Stroke / Q000150:complications / Q000473:pathology* / Q000503:physiopathology