Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Cerebrovasc Dis. 2012;34(5-6):419-23. doi: 10.1159/000345067. Epub 2012 Dec 5.
The National Institutes of Health Stroke Scale (NIHSS) is widely used to measure neurological deficits, evaluate the effectiveness of treatment and predict outcome in acute ischemic stroke. It has also been used to measure the residual neurological deficit at the chronic stage after ischemic events. However, the value of NIHSS in ischemic cerebral small vessel disease has not been specifically evaluated. The purpose of this study was to investigate the link between the NIHSS score and clinical severity in a large population of subjects with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), a unique model to investigate the pathophysiology and natural history of ischemic small vessel disease.
Demographic and clinical data of 220 patients with one or more lacunar infarcts confirmed by MRI examination and enrolled from a prospective cohort study were analyzed. Detailed neurological examinations, including evaluation of the NIHSS and modified Rankin Scale score (mRS) for evaluating the clinical severity, were performed in all subjects. The sensitivity, specificity, positive and negative predictive values of various NIHSS thresholds to capture the absence of significant disability (mRS <3) were calculated. General linear models, controlling for age, educational level and different clinical manifestations frequently observed in CADASIL, were used to evaluate the relationships between NIHSS and clinical severity.
In the whole cohort, 45 (20.5%) subjects presented with mRS ≥3, but only 16 (7.3%) had NIHSS >5. All but 1 subject with NIHSS >5 showed mRS ≥3. NIHSS ≤5 had an 85.3% positive predictive value for no or slight disability with only 33.3% specificity. The NIHSS, MMSE score and presence or absence of gait disturbances were found to be strongly and independently correlated with disability (all p < 0.001). Altogether, they accounted for 73% of the variance of mRS in contrast with the NIHSS alone accounting for only 50% of this variance. Among patients with NIHSS ≤5, subjects with mRS ≥3 showed a lower MMSE score than those with mRS <3 (p < 0.001). All patients with NIHSS ≤5 but with mRS ≥3 presented either with gait disturbances or MMSE score <25.
The present results suggest that the NIHSS cannot reflect the extent of neurological deficit and clinical severity in subjects with lacunar infarctions in the context of a chronic and diffuse small vessel disease. A specific and global neurological scale, including the assessment of cognitive and gait performances, should be developed for ischemic cerebral microangiopathy.
美国国立卫生研究院卒中量表（NIHSS）广泛用于测量神经功能缺损，评估急性缺血性卒中的治疗效果和预测结局。它也被用于测量缺血性事件后慢性期的残余神经缺损。然而，NIHSS 在缺血性脑小血管病中的价值尚未得到专门评估。本研究旨在调查 NIHSS 评分与 CADASIL（伴有皮质下梗死和白质脑病的常染色体显性脑动脉病）患者这一大人群临床严重程度之间的关系，CADASIL 是一种独特的模型，用于研究缺血性小血管病的病理生理学和自然史。
对 220 例经 MRI 检查证实存在一个或多个腔隙性梗死的患者的人口统计学和临床数据进行分析，这些患者均来自一项前瞻性队列研究。对所有患者进行详细的神经学检查，包括 NIHSS 和改良 Rankin 量表评分（mRS）评估临床严重程度。计算各种 NIHSS 阈值以捕捉无明显残疾（mRS <3）的灵敏度、特异性、阳性和阴性预测值。使用控制年龄、教育水平和 CADASIL 中常见的不同临床表现的广义线性模型，评估 NIHSS 与临床严重程度之间的关系。
在整个队列中，45 例（20.5%）患者的 mRS≥3，但只有 16 例（7.3%）患者的 NIHSS>5。NIHSS>5 的患者中，除 1 例外均有 mRS≥3。NIHSS≤5 时，无或轻度残疾的阳性预测值为 85.3%，特异性仅为 33.3%。NIHSS、MMSE 评分和步态障碍的存在与否与残疾高度且独立相关（均 p<0.001）。总的来说，它们共同解释了 mRS 方差的 73%，而 NIHSS 单独仅解释了 50%的方差。在 NIHSS≤5 的患者中，mRS≥3 的患者的 MMSE 评分低于 mRS<3 的患者（p<0.001）。所有 NIHSS≤5 但 mRS≥3 的患者均存在步态障碍或 MMSE 评分<25。
本研究结果表明，在慢性弥漫性小血管病的情况下，NIHSS 不能反映腔隙性梗死患者的神经功能缺损和临床严重程度。应开发一种特定的、全面的神经学量表，包括认知和步态表现的评估，用于缺血性脑微血管病。
Zotero 插件