SERIAL ASSESSMENT OF ACUTE STROKE USING THE NIH STROKE SCALE

Background and Purpose The National Institutes of Health (NIH) Stroke Scale has been used in clinical trials to assess neurological outcome after investigational therapy for acute stroke. We used the NIH Stroke Scale to study the degree and time course of recovery in patients wit h acute stroke who were treated with conventional therapy. Methods We serially assessed 50 patients with ischemic stroke who presented withi n 24 hours of onset of symptoms. Patients were grouped by stroke subty pe. Major neurological improvement was defined as a decrease in the st roke score by 4 points or more. Results The mean NIH stroke score for all patients improved significantly by 7 to 10 days and at last follow -up (average, 44 days). Major neurological improvement was seen in 5 o f 41 patients (12%; 95% confidence interval [CI], 2% to 22%) by 24 hou rs, 11 of 40 patients (28%; 95% CI, 14% to 41%) by 48 hours, and 19 of 37 patients (51%; 95% CI, 35% to 67%) by follow-up. The subgroup of p atients with middle cerebral artery territory embolism showed a simila r pattern of improvement; in contrast, patients with lacunar infarcts did not show significant change in scores during the study period. The score on admission did not correlate with the degree of subsequent im provement or deterioration. Conclusions A significant percentage of pa tients with acute ischemic stroke treated with conventional therapy sh ow early improvement as assessed by the NIH Stroke Scale, The degree a nd time course of recovery may be influenced by stroke type.