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(Stroke. 2004;35:e25.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Cognitive Deficits in Hyperacute Stroke

Neurology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest in the September issue of Stroke the article by Hillis and co-workers and the editorial comment by Merino and Heilman.^1,2 In this very well-conducted study, Hillis et al showed that the National Institute of Health Stroke Scale (NIHSS) is not a reliable scale for assessing stroke severity and outcome because of the lack of items assessing the neuropsychological aspects of deficit, especially for the right hemisphere but also for the left one. Aphasia³ as neglect⁴ have been described to be factors of bad outcome after stroke, and we agree with the authors when they ask for a finest evaluation of cognitive deficits in the hyperacute phase of stroke, those factors being clearly underestimated by the NIHSS. This score may be wrongly reassuring in certain situations and patients with major neuropsychological deficit but without a severe sensory-motor deficit may not receive an acute phase treatment because of a too low score (NIHSS >6 was required for rtPA treatment in the NINDS study⁵).

We recently published results⁶ that could be considered as a first step in developing a short, easy-to-perform, neuropsychological evaluation for refining strategies of acute phase treatment for stroke. A 10-minute bedside score of aphasia, based on the Boston Diagnostic Aphasia Examination,⁷ was developed for the 4 main modalities of language (spontaneous verbal fluency, repetition, comprehension, and naming) and correlated with penumbra dynamics explored by perfusion computed tomography in the hyperacute period (<6 hours from symptoms onset) and diffusion-weighted MRI at . . . [Full Text of this Article]