Abstract
Background and Purpose: The neurological severity of acute ischemic-stroke is evaluated worldwide using the National Institutes of Health stroke scale (NIHSS). In Japan, the Japan Stroke Scale (JSS) which was developed originally in Japan is also used. Several reports have suggested the efficacy of stroke scales for the evaluation of acute ischemic stroke receiving thrombolytic therapy. We assess the clinical usefulness of the NIHSS and JSS in cases receiving local intra-arterial thrombolysis (LIT). Methods: Neurological severity was assessed before, immediately after, and at 24 hours and one month after LIT using the NIHSS and JSS. We evaluated outcome at discharge based on the modified Rankin Scale (mRS) and the Barthel index (BI) score. Results: Sixteen patients receiving LIT underwent assessment by the NIHSS and the JSS. The NIHSS score was significantly related to the JSS score at each time of measucement. The mRS score at discharge was significantly related to both the stroke scale scores at 24 hours and those at one month after LIT. When the NIHSS score improved immediately by 2 or more after LIT and the JSS score improved by 0.65 or more, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for a good outcome (mRS 5 2) at discharge were 0.75 vs. 0.75, 1.00 vs. 0.875, 1.00 vs. 0.875, and 0.80 vs. 0.778, respectively. Conclusion: Periodical evaluation of the NIHSS and JSS in patients with acute middle cerebral artery occlusion receiving LIT is useful for predicting patient outcome at discharge.
