Published Online
on September 8, 2005

A more recent version of this article appeared on October 1, 2005

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Submitted on May 17, 2005
Accepted on July 18, 2005

NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke

Urs Fischer MD; Marcel Arnold MD; Krassen Nedeltchev MD; Caspar Brekenfeld MD; Pietro Ballinari MSc; Luca Remonda MD; Gerhard Schroth MD; and Heinrich P. Mattle MD^*

From the Departments of Neurology (U.F., M.A., H.P.M.), Diagnostic and Interventional Neuroradiology (K.N., C.B., L.R., G.S.), and Psychology (P.B.), University of Bern, Inselspital, Switzerland.

^* To whom correspondence should be addressed. E-mail: heinrich.mattle{at}insel.ch.

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 62±12 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, 155±97 minutes elapsed, and from stroke onset to arteriography 245±100 minutes elapsed. Median NIHSS was 14 (range 3 to 38), and scores differed depending on the arteriographic findings (P<0.001). 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 10 had positive predictive values (PPVs) to show arterial occlusions in 97% of carotid and 96% of vertebrobasilar strokes. With an NIHSS score of 12, 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 10, a vessel occlusion will likely be seen on arteriography, and with a score 12, its location will probably be central.

Key words: angiography, digital subtraction • stroke, acute • thrombolytic therapy

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