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| |  NIHSS Score of Zero May Not Indicate the Absence of a Stroke: Presented at ISC By Ed Susman SAN ANTONIO, Tex -- February 26, 2010 -- Patients who are assessed a National Institutes of Health Stroke Scale (NIHSS) score of “0” -- indicating normal functioning -- might be misdiagnosed as not having had a stroke, researchers said here at the 2010 International Stroke Conference (ISC). “An NIHSS score of 0 does not equal the absence of stroke,” said Sheryl Martin-Schild, MD, Tulane University Stroke Center, New Orleans, Louisiana, during her poster presentation on February 25. “While the NIHSS examination is a useful tool for identifying stroke, not all stroke symptoms are captured as deficits on the NIHSS examination.” Dr. Martin-Schild and colleagues examined the records of 83 patients who were admitted to the stroke centre with neurological conditions suspected of being a stroke, but were given an NIHSS score of 0. She found that 20 of these patients had persistent neurological symptoms that did not resolve. Three-fourths of these patients were discharged to their homes, but 10% of them were sent to skilled nursing facilities. Their mean age was about 54 years and 35% of them were women. About 45% of these patients complained of headaches. The doctors found that 17 additional patients appeared to have experienced a transient ischaemic event that was followed by a stroke. These patients were aged about 69 years, and 41% were women. Their major complaints were headaches and vertigo and limb weakness. The remaining 46 patients were classified as having experienced a clinical transient ischaemic attack that produced brain infarction that was identified on magnetic resonance imaging scans. This group of patients had a mean age of 63 years and 54% were women. Their major complaints were limb weakness and sensory disturbances. Overall, Dr. Martin-Schild said the most common complaints were headache, vertigo, ataxia, confusion, and blurred vision. The scans indicated that patients in these NIHSS = 0 classification appeared to have had impacts with the posterior circulation. “Specifically, the cerebellum, was most commonly infarcted in this group,” she reported. Dr. Martin-Schild said that relying on the NIHSS score could cause future detriments to the patients: [Presentation title: NIHSS = 0 Does NOT Equal the Absence of Stroke. Abstract P84]
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