title: Picturing the Size and Site of Stroke With an Expanded National Institutes of Health Stroke Scale.
abstract: The National Institutes of Health Stroke Scale (NIHSS) includes minimal assessment of cognitive function, particularly in right hemisphere (RH) stroke. Descriptions of the Cookie Theft picture from the NIHSS allow analyses that (1) correlate with aphasia severity and (2) identify communication deficits in RH stroke. We hypothesized that analysis of the picture description contributes valuable information about volume and location of acute stroke.
  
  
  
  We evaluated 67 patients with acute ischemic stroke (34 left hemisphere [LH]; 33 RH) with the NIHSS, analysis of the Cookie Theft picture, and magnetic resonance imaging, compared with 35 sex- and age-matched controls. We evaluated descriptions for total content units (CU), syllables, ratio of left:right CU, CU/minute, and percent interpretive CU, based on previous studies. Lesion volume and percent damage to regions of interest were measured on diffusion-weighted imaging. Multivariable linear regression identified variables associated with infarct volume, independently of NIHSS score, age and sex.
  
  
  
  Patients with RH and LH stroke differed from controls, but not from each other, on CU, syllables/CU, and CU/minute. Left:right CU was lower in RH compared with LH stroke. CU, syllables/CU, and NIHSS each correlated with lesion volume in LH and RH stroke. Lesion volume was best accounted by a model that included CU, syllables/CU, NIHSS, left:right CU, percent interpretive CU, and age, in LH and RH stroke. Each discourse variable and NIHSS score were associated with percent damage to different regions of interest, independently of lesion volume and age.
  
  
  
  Brief picture description analysis complements NIHSS scores in predicting stroke volume and location.
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel
authors.initials: D
authors.lastname: Agis
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Goggins
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Oishi
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oishi
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Cameron
authors.initials: C
authors.lastname: Davis
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Amy
authors.initials: A
authors.lastname: Wright
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Eun Hye
authors.initials: EH
authors.lastname: Kim
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rajani
authors.initials: R
authors.lastname: Sebastian
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Donna C
authors.initials: DC
authors.lastname: Tippett
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Andreia
authors.initials: A
authors.lastname: Faria
authors.affiliation: From the Deparment of Neurology, Johns Hopkins University, Baltimore, MD (D.A., A.E.H.); School of Medicine, University College Dublin, Dublin, Ireland (M.B.G.); and Departments of Radiology (Kumiko Oishi, Kenichi Oishi, A.F.), Neurology (C.D., A.W., E.H.K., R.S., D.C.T., A.E.H.), Otolaryngology (D.C.T.), and PM&R (D.C.T., A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD. argye@jhmi.edu.
authors.forename: Argye E
authors.initials: AE
authors.lastname: Hillis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000453:epidemiology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000523:psychology; D003147:Communication Disorders / Q000453:epidemiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014481:United States
keywords: aphasia; cognition disorders; linear models; magnetic resonance imaging; stroke