Background and Purpose-To test the hypothesis that the National Institutes of Health Stroke Scale (NIHSS) score is associated with the findings of arteriography performed within the first hours after ischemic stroke. Methods-We analyzed NIHSS scores on hospital admission and clinical and arteriographic findings of 226 consecutive patients (94 women, 132 men; mean age 62Ϯ12 years) who underwent arteriography within 6 hours of symptom onset in carotid stroke and within 12 hours in vertebrobasilar stroke. Results-From stroke onset to hospital admission, 155Ϯ97 minutes elapsed, and from stroke onset to arteriography 245Ϯ100 minutes elapsed. Median NIHSS was 14 (range 3 to 38), and scores differed depending on the arteriographic findings (PϽ0.001). NIHSS scores in basilar, internal carotid, and middle cerebral artery M1 and M2 segment occlusions (central occlusions) were higher than in more peripherally located, nonvisible, or absent occlusions. Patients with NIHSS scores Ն10 had positive predictive values (PPVs) to show arterial occlusions in 97% of carotid and 96% of vertebrobasilar strokes. With an NIHSS score of Ն12, PPV to find a central occlusion was 91%. In a multivariate analysis, NIHSS subitems such as "level of consciousness questions," "gaze," "motor leg," and "neglect" were predictors of central occlusions. Conclusions-There is a significant association of NIHSS scores and the presence and location of a vessel occlusion. With an NIHSS score Ն10, a vessel occlusion will likely be seen on arteriography, and with a score Ն12, its location will probably be central. Key Words: angiography, digital subtraction Ⅲ stroke, acute Ⅲ thrombolytic therapy T he National Institutes of Health Stroke Scale (NIHSS) is widely used to assess the severity of acute ischemic stroke. 1 It has been used in many trials and is a validated tool to predict stroke outcome. [2][3][4][5][6] Specifically, it has been used in thrombolysis trials to include or exclude patients from active treatment. [7][8][9] The NIHSS is robust for use by nonneurologists and nurses and also to scale patients retrospectively from chart records. 10 -13 Today, the NIHSS score is used routinely to assess stroke severity in most stroke centers.Patients with acute stroke and without visible vessel occlusion or peripheral occlusions on intra-arterial digital subtraction arteriography (DSA) tend to have a low NIHSS score and a favorable outcome. 14 Furthermore, studies of 54 patients with magnetic resonance (MR) angiography and 43 patients with DSA showed an increasing probability to find vessel occlusions with higher NIHSS scores. 15,16 The presence of a symptomatic cerebral arterial occlusion may have clinical implications for treatment decisions, especially if intra-arterial thrombolysis (IAT) is considered.The aim of the present study was to evaluate the relationship of NIHSS score and DSA findings in a large series of patients who were examined within the first hours after stroke onset. MethodsFrom January 2000 to December 2003, 226 patients with acute isch...

Airway narrowing, gas trapping, and small airway disease are the major targets for functional derangement in ABPA.

Background and Purpose— Intravenous thrombolysis is an approved treatment for anterior (ACS) and posterior (PCS) circulation stroke. However, no randomized controlled trial has investigated safety and efficacy of intravenous thrombolysis according to stroke territory, although PCS is assumed to differ from ACS in many ways. We aimed to compare the safety and clinical outcome of intravenous thrombolysis applied to patients with PCS and ACS. Methods— Prospectively collected data of 883 consecutive patients with acute ischemic stroke (788 ACS, 95 PCS) treated with intravenous thrombolysis in 3 Swiss stroke centers were analyzed. Presenting characteristics, symptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin scale 0 or 1) at 3 months were compared between patients with PCS and ACS. Results— As compared with patients with ACS, those with PCS were younger (mean age, 63 versus 67 years, P =0.012) and had a lower mean baseline National Institutes of Health Stroke Scale score (9 versus 12, P <0.001). Patients with PCS less often had symptomatic intracranial hemorrhage (0% versus 5%, P =0.026) and had more often a favorable outcome (66% versus 47%, P <0.001). Mortality was similar in the 2 groups (PCS, 9%; ACS, 13%; P =0.243). After multivariable adjustment, PCS was an independent predictor of lower symptomatic intracranial hemorrhage frequency ( P =0.001), whereas stroke territory was not associated either with favorable outcome ( P =0.177) or with mortality ( P =0.251). Conclusions— Our study suggests that PCS is associated with a lower risk of symptomatic intracranial hemorrhage after intravenous thrombolysis as compared with ACS, whereas favorable outcome and mortality were similar in the 2 stroke territories.

Eye movement behaviour during visual exploration of 24 patients with probable Alzheimer's disease and 24 age-matched controls was compared in a clock reading task. Controls were found to focus exploration on distinct areas at the end of each clock hand. The sum of these two areas of highest fixation density was defined as the informative region of interest (ROI). In Alzheimer's disease patients, visual exploration was less focused, with fewer fixations inside the ROI, and the time until the first fixation was inside the ROI was significantly delayed. Changes of fixation distribution correlated significantly with the ability to read the clock correctly, but did not correlate with dementia severity. In Alzheimer's disease patients, fixations were longer and saccade amplitudes were smaller. The altered visual exploration in Alzheimer's disease might be related to parietal dysfunction or to an imbalance between a degraded occipito-parietal and relatively preserved occipito-temporal visual network.