Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5.

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY
Maurizio Giorelli, Ruggiero Leone, Sergio Altomare, Anna Digiovanni
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引用次数: 0

Abstract

Objectives: Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features related to stroke characteristics, location, severity, or symptoms could predict the risk of disability after minor strokes.

Methods: Minor strokes (105) were divided into 2 subgroups: those with baseline NIHSS ≤3 and those with baseline NIHSS 4-5. Comorbidities, occurrence of disability, stroke location, etiology, and outcomes were examined in the 2 subgroups and in those who developed a modified Rankin scale (mRs) of 0 to 1 or mRs >1.

Results: No-IVT minor strokes in the NIHSS 4-5 subgroup were associated with more disability compared with the NIHSS ≤3 subgroup (P>0.05). Residual disability (mRS >1) was associated with a higher incidence of posterior circulation strokes (PCS) (P=0.0015), large vessel stenosis (P=0.01), and PCS-related symptoms (imbalance, gait ataxia, and eye movement disorders) not accounted for by NIHSS, in strokes with baseline NIHSS ≤3. Disability (mRS >1) was associated with baseline disabling symptoms, which NIHSS effectively and reliably captured in patients with stroke with NIHSS 4-5.

Conclusions: Symptoms that might predict unfavorable outcomes are not well captured by the available clinical instruments that are usually used to evaluate and score acute ischemic stroke at onset. When deciding on the management of minor stroke, clinicians must consider and judge all potentially disabling deficits, in addition to the pure scores of the adopted evaluation scales.

NIHSS≤3而NIHSS≤4-5的缺血性卒中中,后循环受累可导致更高的残疾。
目的:轻微卒中定义为在美国国立卫生研究院卒中量表(NIHSS)中表现为轻度症状评分≤5分的缺血性脑血管意外。我们的目的是研究与中风特征、部位、严重程度或症状相关的特征是否可以预测轻微中风后残疾的风险。方法:将105例轻度脑卒中患者分为基线NIHSS≤3组和基线NIHSS 4-5组。在两个亚组和采用改良Rankin量表(mRs) 0 - 1或mRs 0 - 1的患者中检查合并症、残疾发生、卒中部位、病因和结局。结果:与NIHSS≤3亚组相比,NIHSS 4-5亚组无ivt轻度卒中的致残率更高(P < 0.05)。在基线NIHSS≤3的卒中中,残余残疾(mRS bbb1)与较高的后循环卒中(PCS) (P=0.0015)、大血管狭窄(P=0.01)和未被NIHSS考虑的PCS相关症状(失衡、步态共济失调和眼动障碍)发生率相关。残障(mRS >1)与基线残障症状相关,NIHSS有效可靠地捕获了NIHSS 4-5的脑卒中患者的残障症状。结论:可用的临床仪器在急性缺血性中风发作时通常用于评估和评分,但不能很好地捕捉到可能预示不良结果的症状。在决定对轻微中风的治疗时,除了采用的评估量表的纯分数外,临床医生还必须考虑和判断所有潜在的致残缺陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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