Change in Perfusion in Acute Nondominant Hemisphere Stroke May Be Better Estimated by Tests of Hemispatial Neglect Than by the National Institutes of Health Stroke Scale

Background and Purpose— 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. Methods— 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. Results— 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). Conclusions— Tests of hemispatial neglect may better reflect dysfunction and reperfusion than NIHSS for patients with nondominant hemisphere stroke.