Abstract
Stroke patients admitted to neurosurgical departments first undergo a decision making process whether medical or surgical treatment is needed. Besides various imaging studies, patients' neurological symptoms hold a significant role for the decision. The purpose of this investigation was to test if the Japan Stroke Scale (JSS) is useful in neurosurgical decision making for acute stroke patients. Forty nine acute stroke patients, 15 intracrebral hemorrhages, 18 cerebral infarctions and 16 subarachnoid hemorrhages, were examined by four neurosurgeons using JSS. Although the reproducibility among investigators was high, several problems were pointed out including 1) several items were not applicable to patients with signigicant consciousness distur-bance, 2) making borderlines between medical treatment and surgical treatment was often difficult using JSS. probably because poor discrimination among patients with significant consciousness disturbance and 3) more specifically, it might be a problem that the Japan coma scales 1 and 30, and 100 and 300 were grouped in the same grade respectively in the JSS. In conclusion, JSS, which seems more suitable to patients with less consciousness disturbance, appeared sometimes difficult to apply to acute stroke patients with more severe consciousness disturbance. Future investigation is necessary to clarify if the JSS in applicable to decide indications of neurosurgical interventions.
