National institutes of health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke

Heldner, Mirjam Rachel; Zubler, Christoph; Mattle, Heinrich P.; Schroth, Gerhard; Weck, Anja; Mono, Marie-Luise; Gralla, Jan; Jung, Simon; El-Koussy, Marwan; Lüdi, Rudolf; Yan, Xin; Arnold, Marcel; Ozdoba, Christoph; Mordasini, Pasquale; Fischer, Urs (2013). National institutes of health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke. Stroke, 44(4), pp. 1153-1157. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/STROKEAHA.111.000604

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Background and Purpose—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.

Item Type:

Journal Article (Further Contribution)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Heldner, Mirjam Rachel, Zubler, Christoph, Mattle, Heinrich, Schroth, Gerhard, Weck, Anja, Mono, Marie-Luise, Gralla, Jan, Jung, Simon, El-Koussy, Marwan, Lüdi, Rudolf, Arnold, Marcel, Ozdoba, Christoph, Mordasini, Pasquale Ranato, Fischer, Urs Martin


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Factscience Import

Date Deposited:

04 Oct 2013 14:36

Last Modified:

02 Mar 2023 23:21

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URI: (FactScience: 221290)

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