Published Online
on September 4, 2003

A more recent version of this article appeared on October 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/10/2392    most recent 01.STR.0000089681.84041.69v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hillis, A. E. Articles by Jacobs, M. A. Search for Related Content PubMed PubMed Citation Articles by Hillis, A. E. Articles by Jacobs, M. A. Related Collections Acute Stroke Syndromes Behavioral Changes and Stroke Computerized tomography and Magnetic Resonance Imaging

Submitted on May 13, 2003
Accepted on June 4, 2003

Change in Perfusion in Acute Nondominant Hemisphere Stroke May Be Better Estimated by Tests of Hemispatial Neglect Than by the National Institutes of Health Stroke Scale

Argye E. Hillis MD, MA^*; Robert J. Wityk MD; Peter B. Barker DPhil; John A. Ulatowski MD, PhD; and Michael A. Jacobs PhD

From the Departments of Neurology (A.E.H., R.J.W., J.A.U.), Radiology, Division of Neuroradiology (P.B.B., M.A.J.), Anesthesiology and Critical Care Medicine (J.A.U.), and Neurosurgery (J.A.U.), Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: argye{at}JHMI.edu.

Background and Purpose--It has been reported that National Institutes of Health Stroke Scale (NIHSS) scores correlate poorly with hypoperfused tissue measured by perfusion-weighted imaging (PWI) in nondominant hemisphere stroke. We conducted 2 studies to determine whether tests of hemispatial neglect provide a better measure of hypoperfusion and reperfusion than NIHSS in nondominant hemisphere stroke.

Methods--In study 1, 74 patients with acute ischemic, supratentorial stroke were administered the NIHSS, tests of neglect or aphasia, and diffusion-weighted imaging (DWI) and PWI on day 1 (<24 hours from onset) of stroke. Pearson correlations between volumes of PWI/DWI abnormality and functional tests were calculated. In study 2, 10 patients with acute, nondominant hemisphere stroke who were candidates for intervention to restore perfusion underwent PWI, DWI, NIHSS, and a line cancellation test on days 1 and 3. Correlations between change in volumes of PWI/DWI abnormality and change in functional tests were calculated.

Results--In study 1, in nondominant hemisphere stroke, volume of PWI abnormality correlated significantly with neglect scores (r=0.71; P<0.002) but not with NIHSS scores (r=0.39; P=NS). In dominant hemisphere stroke, volume of PWI abnormality correlated better with aphasia scores (r=0.50; P=0.0001) than with NIHSS scores (r=0.45; P=0.001). In study 2, change in volume of hypoperfused tissue on PWI correlated with change in line cancellation performance (r=0.83; P=0.003) but not with change in NIHSS score (r=0.26; P=NS).

Conclusions--Tests of hemispatial neglect may better reflect dysfunction and reperfusion than NIHSS for patients with nondominant hemisphere stroke.

Key words: cognition • magnetic resonance imaging, perfusion-weighted • reperfusion • stroke assessment

This article has been cited by other articles:

				P. Shirani, J. Thorn, C. Davis, J. Heidler-Gary, M. Newhart, R. F. Gottesman, and A. E. Hillis Severity of Hypoperfusion in Distinct Brain Regions Predicts Severity of Hemispatial Neglect in Different Reference Frames Stroke, November 1, 2009; 40(11): 3563 - 3566. [Abstract] [Full Text] [PDF]

				J. A. Alawneh, R. R. Moustafa, and J.-C. Baron Hemodynamic Factors and Perfusion Abnormalities in Early Neurological Deterioration Stroke, June 1, 2009; 40(6): e443 - e450. [Abstract] [Full Text] [PDF]

				J.M. Provenzale, K. Shah, U. Patel, and D.C. McCrory Systematic Review of CT and MR Perfusion Imaging for Assessment of Acute Cerebrovascular Disease AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1476 - 1482. [Abstract] [Full Text] [PDF]

				G. M. S. Nys, M. J. E. v. Zandvoort, H. B. v. d. Worp, L. J. Kappelle, and E. H. F. d. Haan Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke. Brain, August 1, 2006; 129(Pt 8): 2148 - 2157. [Abstract] [Full Text] [PDF]

				S. Di Legge, J. Fang, G. Saposnik, and V. Hachinski The impact of lesion side on acute stroke treatment Neurology, July 12, 2005; 65(1): 81 - 86. [Abstract] [Full Text] [PDF]

				A. E. Hillis, M. Newhart, J. Heidler, P. B. Barker, E. H. Herskovits, and M. Degaonkar Anatomy of Spatial Attention: Insights from Perfusion Imaging and Hemispatial Neglect in Acute Stroke J. Neurosci., March 23, 2005; 25(12): 3161 - 3167. [Abstract] [Full Text] [PDF]

				G. M.S. Nys, M. J.E. van Zandvoort, P. L.M. de Kort, H. B. van der Worp, B. P.W. Jansen, A. Algra, E. H.F. de Haan, and L. J. Kappelle The prognostic value of domain-specific cognitive abilities in acute first-ever stroke Neurology, March 8, 2005; 64(5): 821 - 827. [Abstract] [Full Text] [PDF]

				L. A. Reineck, S. Agarwal, and A. E. Hillis "Diffusion-clinical mismatch" is associated with potential for early recovery of aphasia Neurology, March 8, 2005; 64(5): 828 - 833. [Abstract] [Full Text] [PDF]

				A. E. Hillis, M. Work, P. B. Barker, M. A. Jacobs, E. L. Breese, and K. Maurer Re-examining the brain regions crucial for orchestrating speech articulation Brain, July 1, 2004; 127(7): 1479 - 1487. [Abstract] [Full Text] [PDF]

				A. Croquelois and J. Bogousslavsky Cognitive Deficits in Hyperacute Stroke Stroke, February 1, 2004; 35 (2): e25 - e25. [Full Text] [PDF]

				J. G. Merino and K. M. Heilman Editorial Comment--Measurement of Cognitive Deficits in Acute Stroke Stroke, October 1, 2003; 34(10): 2396 - 2398. [Full Text] [PDF]