Hillis Argye E, Wityk Robert J, Barker Peter B, Ulatowski John A, Jacobs Michael A
Department of Neurology, Johns Hopkins University School of Medicine, Meyer 5-185, 600 N Wolfe St, Baltimore, Md 21287, USA.
Stroke. 2003 Oct;34(10):2392-6. doi: 10.1161/01.STR.0000089681.84041.69. Epub 2003 Sep 4.
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.
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.
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).
Tests of hemispatial neglect may better reflect dysfunction and reperfusion than NIHSS for patients with nondominant hemisphere stroke.
据报道，在非优势半球卒中中，美国国立卫生研究院卒中量表（NIHSS）评分与灌注加权成像（PWI）测量的灌注不足组织相关性较差。我们进行了两项研究，以确定在非优势半球卒中中，半侧空间忽视测试是否比NIHSS能更好地评估灌注不足和再灌注情况。
在研究1中，74例急性缺血性幕上卒中患者在卒中第1天（发病<24小时）接受了NIHSS、忽视或失语测试、弥散加权成像（DWI）和PWI检查。计算PWI/DWI异常体积与功能测试之间的Pearson相关性。在研究2中，10例急性非优势半球卒中且有恢复灌注干预指征的患者在第1天和第3天接受了PWI、DWI、NIHSS和直线划消测试。计算PWI/DWI异常体积变化与功能测试变化之间的相关性。
在研究1中，在非优势半球卒中中，PWI异常体积与忽视评分显著相关（r = 0.71；P < 0.002），但与NIHSS评分无关（r = 0.39；P =无统计学意义）。在优势半球卒中中，PWI异常体积与失语评分的相关性（r = 0.50；P = 0.0001）优于与NIHSS评分的相关性（r = 0.45；P = 0.001）。在研究2中，PWI上灌注不足组织体积的变化与直线划消表现的变化相关（r = 0.83；P = 0.003），但与NIHSS评分变化无关（r = 0.26；P =无统计学意义）。
对于非优势半球卒中患者，半侧空间忽视测试可能比NIHSS能更好地反映功能障碍和再灌注情况。
