Woo D, Broderick J P, Kothari R U, Lu M, Brott T, Lyden P D, Marler J R, Grotta J C
Department of Neurology, University of Cincinnati, Cincinnati, Ohio 45220, USA.
Stroke. 1999 Nov;30(11):2355-9. doi: 10.1161/01.str.30.11.2355.
The National Institutes of Health Stroke Scale (NIHSS) is a valid, reproducible scale that measures neurological deficit. Of 42 possible points, 7 points are directly related to measurement of language compared with only 2 points related to neglect.
We examined the placebo arm of the NINDS t-PA stroke trial to test the hypothesis that the total volume of cerebral infarction in patients with right hemisphere strokes would be greater than the volume of cerebral infarction in patients with left hemisphere strokes who have similar NIHSS scores. The volume of stroke was determined by computerized image analysis of CT films and CT images stored on computer tape and optical disks. Cube-root transformation of lesion volume was performed for each CT. Transformed lesion volume was analyzed in a logistic regression model to predict volume of stroke by NIHSS score for each hemisphere. Spearman rank correlation was used to determine the relation between the NIHSS score and lesion volume.
The volume for right hemisphere stroke was statistically greater than the volume for left hemisphere strokes, adjusting for the baseline NIHSS (P<0. 001). For each 5-point category of the NIHSS score <20, the median volume of right hemisphere strokes was approximately double the median volume of left hemisphere strokes. For example, for patients with a left hemisphere stroke and a 24-hour NIHSS score of 16 to 20, the median volume of cerebral infarction was 48 mL (interquartile range 14 to 111 mL) as compared with 133 mL (interquartile range 81 to 208 mL) for patients with a right hemisphere stroke (P<0.001). The median volume of a right hemisphere stroke was roughly equal to the median volume of a left hemisphere stroke in the next highest 5-point category of the NIHSS. The Spearman rank correlation between the 24-hour NIHSS score and 3-month lesion volume was 0.72 for patients with left hemisphere stroke and 0.71 for patients with right hemisphere stroke.
For a given NIHSS score, the median volume of right hemisphere strokes is consistently larger than the median volume of left hemisphere strokes. The clinical implications of our finding need further exploration.
美国国立卫生研究院卒中量表（NIHSS）是一种有效且可重复的用于测量神经功能缺损的量表。在42个可能的评分点中，有7个点直接与语言测量相关，而与忽视相关的只有2个点。
我们研究了美国国立神经疾病与卒中研究所（NINDS）组织型纤溶酶原激活剂（t-PA）治疗卒中试验中的安慰剂组，以检验以下假设：在具有相似NIHSS评分的患者中，右半球卒中患者的脑梗死总体积将大于左半球卒中患者的脑梗死体积。通过对CT胶片以及存储在计算机磁带和光盘上的CT图像进行计算机图像分析来确定卒中体积。对每个CT进行病变体积的立方根变换。在逻辑回归模型中分析变换后的病变体积，以根据每个半球的NIHSS评分预测卒中体积。采用Spearman等级相关性分析来确定NIHSS评分与病变体积之间的关系。
在校正基线NIHSS评分后，右半球卒中的体积在统计学上大于左半球卒中的体积（P<0.001）。对于NIHSS评分<20的每5分等级，右半球卒中的中位数体积约为左半球卒中中位数体积的两倍。例如，对于左半球卒中且24小时NIHSS评分为16至20的患者，脑梗死的中位数体积为48 mL（四分位间距为14至111 mL），而右半球卒中患者的中位数体积为133 mL（四分位间距为81至208 mL）（P<0.001）。在NIHSS评分的下一个最高5分等级中，右半球卒中的中位数体积大致等于左半球卒中的中位数体积。左半球卒中患者24小时NIHSS评分与3个月时病变体积的Spearman等级相关性为0.72，右半球卒中患者为0.71。
对于给定的NIHSS评分，右半球卒中的中位数体积始终大于左半球卒中的中位数体积。我们这一发现的临床意义需要进一步探索。
