Relationship between Ischemic Lesion Volume and Functional Status in the 2nd Week after Middle Cerebral Artery Stroke

Schiemanck, Sven K.; Post, Marcel W M; Witkamp, T. D.; Kappelle, L. Jaap; Prevo, A. J. H.

doi:10.1177/154596830501900207

Cited by 55 publications

(36 citation statements)

References 31 publications

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“…Another potential limitation is the clinical utility of a measure that predicts infarct volume. A few authors have reported associations with DWI volume and functional scales (such as the Barthel Index) [16,17] but it will be important to determine that a clinical assessment of volume of ischemia truly corresponds to tangible patient outcomes. The NIHSS is least associat-ed with functional outcomes in patients with cortical strokes [4]; it is likely that the NIHSS-plus would be more predictive than the NIHSS particularly for cortical strokes, as illustrated in Figure 1.…”

Section: Discussionmentioning

confidence: 99%

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

Gottesman

Kleinman

Davis

et al. 2010

Behavioural Neurology

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Background The National Institutes of Health Stroke Scale (NIHSS) has been criticized for limited representation of cognitive dysfunction and bias towards dominant hemisphere functions. Patients may therefore receive a low NIHSS score despite a fairly large stroke. A broader scale including simple cognitive tests would improve the clinical and research utility of the NIHSS. Methods We studied 200 patients with acute non-dominant hemispheric stroke who underwent cognitive testing and had MRI with diffusion-weighted imaging (DWI) within 5 days of presentation. We measured DWI volumes and retrospectively calculated NIHSS scores. We used linear regression to determine the role of selected cognitive tests, when added to the NIHSS, in predicting DWI volume. Results The NIHSS predicted DWI volume in a univariate analysis, as did total line cancellation and a visual perception task. In a multivariate model, using log-transformed variables, the NIHSS (p=0.0002), line cancellation errors (p=0.02) and visual perception (p=0.004) each improved prediction of total infarct volume. Conclusion The addition of line cancellation and visual perception tasks significantly adds to the model of NIHSS alone in predicting DWI volume. We propose that these two cognitive tests, which together can be completed in 2-3 minutes, could be combined with the NIHSS to create an “NIHSS-plus” that more accurately represents a patient’s ischemic tissue volume after a stroke. This scale requires further validation in a prospective study.

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Section: Discussionmentioning

confidence: 99%

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

Gottesman

Kleinman

Davis

et al. 2010

Behavioural Neurology

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“…In patients with middle cerebral artery strokes, ischemic lesion volume correlates strongly with NIHSS score. 7 On the other hand, outcome-preference surveys indicate that a majority of stroke victims or potential stroke victims most value a complete functional recovery. 8,9 The latter is best reflected by an mRS score of 0 or 1.…”

Section: Methodsmentioning

confidence: 99%

The ALIAS Pilot Trial

Palesch

Hill

Ryckborst

et al. 2006

Stroke

121

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Background and Purpose-High-dose human albumin (ALB) is robustly neuroprotective in rodent stroke models. A phase I dose-escalation study was conducted to assess the safety of ALB therapy in ischemic stroke. We analyzed the data for preliminary evidence of treatment efficacy. Methods-Eighty-two subjects with acute ischemic stroke (NIH Stroke Scale [NIHSS] of 6 or above) received 25% ALB beginning within 16 hours of stroke onset. Six successive ALB dose tiers were assessed (range, 0.34 to 2.05 g/kg). Forty-two patients also received standard-of-care intravenous tissue plasminogen activator (tPA). Efficacy outcomes were determined at 3 months. We compared the highest three, putatively therapeutic ALB dose tiers (1.37 to 2.05 g/kg) with the lowest three, presumed subtherapeutic doses (0.34 to 1.03 g/kg) and with historical cohort data derived from the NINDS rt-PA Stroke Study. Results-After adjusting for the tPA effect, the probability of good outcome (defined as modified Rankin Scale 0 to 1 or NIH Stroke Scale 0 to 1 at 3 months) at the highest three ALB doses was 81% greater than in the lower dose-tiers (relative risk [RR], 1.81; 95% confidence interval [CI], 1.11 to 2.94) and was 95% greater than in the comparable NINDS rt-PA Stroke Study cohort (RR, 1.95; 95% CI, 1.47 to 2.57). The tPA-treated subjects who received higher-dose ALB were three times more likely to achieve a good outcome than subjects receiving lower-dose ALB, suggesting a positive synergistic effect between ALB and tPA. Conclusions-Our data suggest that high-dose ALB therapy may be neuroprotective after ischemic stroke. These results have led to a multicenter, randomized, placebo-controlled efficacy trial of ALB in acute ischemic stroke-the ALIAS

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“…The scale contains domains similar to the NIHSS: level of consciousness, best gaze, visual field, facial palsy, and motor arm and motor leg, for which each domain is categorically rated by level of impairment to absence of abnormality (see Wilde et al, 2010 for a more detailed description of the modifications to the NIHSS). Although the NIHSS has undergone adequate validation in stroke populations through comparison with other stroke scales (D'Olhaberriague et al, 1996;Lyden and Lau, 1991;Lyden et al, 2001;Young et al, 2005), the Glasgow Outcome Scale, and imaging (Brott et al, 1989;Derex et al, 2004;Lyden et al, 2004;Meyer, 1998;Saver et al, 1999;Schiemanck et al, 2005), measures of neurological functioning such as the NIHSS are rarely validated against what is arguably the gold standard for neurological functioning: a clinical neurological examination performed by a neurologist. Accordingly, we evaluated the construct validity of the NOS-TBI using a quantified clinical neurological examination in a sample of patients with TBI currently undergoing post-acute rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): I. Construct Validity

Wilde

McCauley

Kelly

et al. 2010

Journal of Neurotrauma

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The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) is a measure adapted from the National Institutes of Health Stroke Scale (NIHSS), and is intended to capture essential neurological deficits impacting individuals with traumatic brain injury (TBI) (see Wilde et al., 2010 ). In the present study we evaluate the measure's construct validity via comparison with a quantified neurological examination performed by a neurologist. Spearman rank-order correlation between the NOS-TBI and the neurological examination was rho = 0.76, p < 0.0001, suggesting a high degree of correspondence (construct validity) between these two measures of neurological function. Additionally, items from the NOS-TBI compared favorably to the neurological examination items, with correlations ranging from 0.60 to 0.99 (all p < 0.0001). On formal neurological examination, some degree of neurological impairment was observed in every participant in this cohort of individuals undergoing rehabilitation for TBI, and on the NOS-TBI neurological impairment was evident in all but one participant. This study documents the presence of measurable neurological sequelae in a sample of patients with TBI in a post-acute rehabilitation setting, underscoring the need for formal measurement of the frequency and severity of neurological deficits in this population. The results suggest that the NOS-TBI is a valid measure of neurological functioning in patients with TBI.

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Relationship between Ischemic Lesion Volume and Functional Status in the 2nd Week after Middle Cerebral Artery Stroke

Abstract: Lesion volume is moderately to strongly related to the functional status in the 2nd week poststroke.

Cited by 55 publications

References 31 publications

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

The NIHSS-Plus: Improving Cognitive Assessment with the NIHSS

The ALIAS Pilot Trial

The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): I. Construct Validity

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