Zero on the NIHSS Does Not Equal the Absence of Stroke

Abstract

Study objective The National Institutes of Health Stroke Scale (NIHSS) measures deficits caused by a stroke, but not all stroke signs are captured on the NIHSS. We determined the symptoms and stroke localization of patients with brain infarction and an NIHSS score of 0. Methods We studied all patients who presented with acute neurological symptoms to our stroke center from 2004–2008, had persistent symptoms at the time of evaluation in the emergency department, an NIHSS score of 0, and an infarct on diffusion weighted imaging (DWI). We characterized the symptoms, signs, lesion location, demographics and stroke etiologies. Results 20 patients met inclusion criteria. Symptoms frequently experienced were headache, vertigo, and nausea. The posterior circulation was commonly infarcted in this group. Truncal ataxia was the most common neurological sign. Conclusion Ischemic stroke may cause symptoms that are associated with no deficits on the NIHSS score.

Can 90-Day NIHSS Be Used for Outcome Assessment in TIA and Minor Stroke Studies?

“…Potential explanations include the presence of gait ataxia or cranial nerve palsies, which are not well captured by the NIHSS. This finding is concordant with the observation that patients with stroke in the posterior circulation tend to have lower NIHSS at presentation [4,5] , while having a significant risk of disability [6] . Another limitation of NIHSS includes a bias towards higher scores in left hemispheric strokes.…”

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

“…The initial NIHSS score of all cerebral infarction patients in the present study was 0.Symptoms such as dizziness, headache, and nausea, do not constitute points using the NIHSS (Martin‐Shild et al., 2011). These findings indicate that NIHSS scoring is insensitive and misleading if it is used to guide decision‐making for posterior circulation infarction.…”

Tid er hjerne – også når det bakre kretsløp rammes

“…Skalaen er vektet mer mot slag i forsyningsområdet til det fremre kretsløpet (8). Den gir høyest skår ved motoriske og kortikale symptomer, noe lavere skår ved ekstremitetsataksi og hjernenerveutfall, mens trunkal ataksi og nystagmus ikke gir poeng.…”