title: National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke.
abstract: OBJECTIVE
  There is some controversy on the association of the National Institutes of Health Stroke Scale (NIHSS) score to predict arterial occlusion on MR arteriography and CT arteriography in acute stroke.
  
  
  METHODS
  We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66 ± 14 years) with acute anterior or posterior circulation strokes.
  
  
  RESULTS
  The study included 1603 patients examined with MR arteriography and 549 with CT arteriography. Of those, 1043 patients (48.5%; median NIHSS score 5, median time to clinical assessment 179 minutes) showed an occlusion, 887 in the anterior (median NIHSS score 7/0-31), and 156 in the posterior circulation (median NIHSS score 3/0-32). Eight hundred sixty visualized occlusions (82.5%) were located centrally (ie, in the basilar, intracranial vertebral, internal carotid artery, or M1/M2 segment of the middle cerebral artery). NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation. Best cut-off values within 3 hours after symptom onset were NIHSS scores ≥ 9 (positive predictive value 86.4%) and NIHSS scores ≥ 7 within >3 to 6 hours (positive predictive value 84.4%). Patients with central occlusions presenting within 3 hours had NIHSS scores <4 in only 5%. In the posterior circulation and in patients presenting after 6 hours, the predictive value of the NIHSS score for vessel occlusion was poor.
  
  
  CONCLUSIONS
  There is a significant association of NIHSS scores and vessel occlusions in patients with anterior circulation strokes. This association is best within the first hours after symptom onset. Thereafter and in the posterior circulation the association is poor.
authors.affiliation: Department of Neurology, University of Bern, Bern, Switzerland.
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.forename: Christoph
authors.initials: C
authors.lastname: Zubler
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Anja
authors.initials: A
authors.lastname: Weck
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Rudolf
authors.initials: R
authors.lastname: Lüdi
authors.forename: Xin
authors.initials: X
authors.lastname: Yan
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Christoph
authors.initials: C
authors.lastname: Ozdoba
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D009316:National Institutes of Health (U.S.); D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States