Relationship Between NIHSS score National Institues Of Healt Stroke Scale Scores , Vessel Occlusion And Affected Hemisphere In Acute Ischemic Stroke

Yıl 2016, Cilt: 5 Sayı: 1, 8 - 15, 01.01.2016

Muhammed Nur Ögün Bahar Aksay Koyuncu Özlem Güngör Tuncer Gökhan Evcili Reha Tolun Yakup Krespi

https://doi.org/10.5505/abantmedj.2016.28482

Öz

INTRODUCTION: The NIH Stroke Scale NIHSS is used to assess acute ischemic stroke severity and outcome, however, it can award more points for tests of presumed left-hemisphere function, such as language, than for tests of right-hemisphere function, such as neglect. This difference may be important if a low NIHSS score is used to exclude patients with right-hemisphere stroke from clinical trials or established treatments. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of side of stroke lesion to clinical evaluation in this association is. We tested the NIHSS scores as an instrument to determine arterial occlusion within 12 hours of stroke onset. The aim of this study was to investigate whether the relationship between acute NIHSS score and arteral occlusion as determined by acute MR angiography differs between right- and left-sided stroke. METHODS: This was a retrospective study of 139 patients with acute stroke seen at Florence Nightingale Stroke Center who underwent an MRI examination and NIHSS within 12 hours of stroke onset. NIHSS score was recorded prospectively by the admitting stroke fellow at the time of acute presentation, immediately preceding imaging. Computerized volumetric analysis of the MRI lesions, intracranial MR anjiography evaluation was performed by investigators blinded to clinical data.RESULTS: Mean ±SD NIHSS score was 9,7 ± 6,7 Receiver operating characteristic curves showed that the validity of NIHSS in predicting arterial occlusion was smilar in patients between left and right-sided stroke. The best cut-off point in patients evaluated with left-sided stroke was an NIHSS of 8 83 % sensitivity, specificity 84 % , while in patients evaluated after with right-sided stroke best cut-off point was 9 sensitivity 72 %, specificity 72 % .DISCUSSION AND CONCLUSION: The validity of NIHSS in predicting arterial occlusion was smilar in patients between left and right-sided Right 9, Left 8 stroke. S in predicting arterial occlusion was smilar in patients between left and right-sided Right 9, Left 8 stroke. An NIHSS score of 8 seems to represent the cut-off for discriminating between patients with arterial occlusion and patients without.

Anahtar Kelimeler

National Institues of Health Stroke

Akut İskemik İnmede Damar Okluzyonu, NIHSS Skoru National Institues Of Healt Stroke Scale Scores İle Tutulan Hemisfer Arasındaki İlişki

Öz

GİRİŞ ve AMAÇ: AMAÇ: Ulusal İnme Sağlık Ölçeği Skalası NIHSS akut iskemik inmenin şiddetini belirlemede kullanılır. Ancak dil fonksiyonu gibi sol hemisfer fonksiyonlarının, ihmal gibi sağ hemisfer fonksiyonlarına göre daha yüksek NIHSS skoru teşkil ettiği bilinmektedir. Bu durum sağ hemisfer inmeli düşük NIHSS skorlu hastaların tedaviden dışlanmasına sebep olabilir. Yüksek NIHSS skoru genellikle intrakranyal arter okluzyonu ile ilişkilidir, ancak tutulan hemisferin Sağ ya da sol hemisfer inmesi damar okluzyonunu ön gördüren NIHSS skoruna etkisi bilinmemektedir. Çalışmamızda inmenin ilk 12 saatinde başvuran hastaların NIHSS skoru ve arteriyel okluzyon varlığı değerlendirildi. Bu çalışmanın amacı akut intrakranyal MR anjiografi ile belirlenen damar okluzyonunun, NIHSS skoru ile ilişkisinin sağ ve sol taraflı inmeli hastalar arasında farklı olup olmadığının araştırmaktır. YÖNTEM ve GEREÇLER: YÖNTEMLER: Bu çalışma, 2006-2009 yılları arasında Florence Nigtingale İnme Merkezi’ne inme başlangıcından 12 saat içinde başvuran ve DWI MR ve İntrakranyal MR anjiografi yapılmış olan 139 hastanın verilerinden retrospektif olarak yapıldı. NIHSS skoru görüntülemenin hemen öncesinde bir Nöroloji hekimi tarafından kaydedildi. İntrakranyal MR anjiografi incelemeleri hastaların klinik verilerinden habersiz bir Nörolog ve Nöroradyolog tarafından yapıldı.BULGULAR: Mean ± SD NIHSS skoru 9,7 ± 6,7 idi. ROC Eğrisi ile arter tıkanıklığını ön gördüren NIHSS Cut-Off değeri sağ ve sol taraflı inme arasında hastalarda benzerdi. Sol taraf inmeli hastalarda damar okluzyonunu ön gördüren Cut-off noktası 8 duyarlılık % 83, özgüllük % 84 idi. Sağ taraf inmeli hastalarda damar okluzyonunu ön gördüren Cutoff noktası 9 Duyarlılık % 72, özgüllük % 72 idi.TARTIŞMA ve SONUÇ: SONUÇ: Arter tıkanıklığını ön gördürmede NIHSS skorunun Cut-Off değeri sağ ve sol taraflı Sağ 9, Sol 8 inme arasında hastalarda benzerdi. Tüm grup göz önüne alındığında arteriyel okluzyonu ön gördüren NIHSS skoru 8 düzeyinde saptandı.

Anahtar Kelimeler

Ulusal İnme Sağlık Ölçeği Skalası

Kaynakça

• Luker JA, Bernhardt J, Grimmer- Somers KA. Demographic and stroke- related factors as predictors of quality of acute stroke care provided by allied health professionals. J Multidiscip Healthc. 2011; 4: 247–259. 2.
• Boone M, Chillon JM, Garcia PY, Canaple S, Lamy C, Godefroy O, Bugnicourt JM. NIHSS and acute complications after anterior and posterior circulation strokes. Therapeutics and Clinal Risk Management 2012; 8: 87–93. 3.
• Dara C, Bang J, Gottesman RF, Hillis AE. Right Hemisphere Dysfunction is Better Predicted by Emotional Prosody Impairments as Compared to Neglect. J Neurol Transl Neurosci 2014: 2(1): 1037.
• Kettunen J. Visual Neglect and Orienting Bias in Right Hemisphere Stroke Patients with and without Thrombolysis. 2013: 1455-1616 5.
• Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS) Journal of Physiotherapy. 2014: vol 60, issue 1, page 61 6
• strategies of care across stroke recovery: Proposals for nursing interventions in primary care. Clinical Nursing Studies 2015: Vol. 3. No. 2 7.
• Mansour OY, Megahed MM, Eman HS, Elganhy A. Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHSS scale and Full Outline of UnResponsiveness Score in intensive care unit. Alexandria Journal of Medicine,2014:10.002 8.
• Fischer U, Mono ML, Zwahlen M, Nedeltchev K, Arnold M, Galimanis A, Bucher S, Findling O, Meier N, Brekenfeld C, Gralla J, Heller R, Tschannen B, Schaad H, Waldegg G, Zehnder T, Ronsdorf A, Oswald P, Brunner G, Schroth G, Mattle HP, the QABE investigators. Impact of thrombolysis on stroke outcome at 12 months in a population: The Bern Stroke Project. Stroke 2012; 43: 1039–1045 9
• Shibazaki K, Sakamoto Y, Aoki J. The role of small vessel disease in re-exacerbation of stroke symptoms within 24 hours after tissue plasminogen activator infusion. Journal of Stroke and Cerebrovascular Diseases 2014; Volume 23, Issue 1, Pages 75–79
• Golsari A, Cheng B, Sobesky J, Schellinger PD, Fiehler J, Gerloff C, Thomalla G. Stroke lesion volumes and outcome are not different in hemispheric stroke side treated with intravenous thrombolysis based on magnetic resonance imaging criteria. Stroke 2015; 46: 1004–1008
• Heldner MR, Zubler C, Mattle HP, Schroth G, Weck A, Mono ML, Gralla J, Jung S, El-Koussy M, Lüdi R, Yan X, Arnold M, Ozdoba C, Mordasini P, Fischer U. National Institutes of Health Stroke Scale Score and vessel occlusion in 2.152 Patients with acute ischemic stroke. Stroke 2013; 44: 1153–1157
• Cooray C, Fekete K, Mikulik R, Lees KR, Wahlgren N, Ahmed N. Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis. International Journal of Stroke 2015: Volume 10, Issue 5, Pages 645–788
• Hansen CK, Christensen A, Ovesen C, Havsteen I, Christensen H. Stroke severity and incidence of acute large vessel occlusions in patients with hyper- acute cerebral ischemia: results from a prospective cohort study based on CT- angiography (CTA). International Journal of Stroke 2015: Volume 10, Issue 3, pages 336–342