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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
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HILLIS AE; WITYK RJ; BARKER PB
STROKE , 2003, vol. 34, n° 10, p. 2392-2396 Doc n°: 110713 Localisation : Documentation IRR Descripteurs : AF21 - ACCIDENTS VASCULAIRES CEREBRAUX Url : http://intl-stroke.ahajournals.org/cgi/content/full/34/10/2392 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. Langue : ANGLAIS Tiré à part : OUI Identifiant basis : 2003228814 |
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