NIH Stroke Scale as a Predictor of Clot Presence, Location, and Persisting Occlusion in Candidates for Thrombolysis

Background: In acute stroke, few tools are readily available to determine clot presence and location before thrombolysis, nor whether occlusion persists after intravenous TPA. Because the NIH Stroke Scale (NIHSS) is easily obtained in the Emergency Department, we correlated sequential NIHSS scores and arterial occlusion in prospective candidates for IV TPA. Methods: Potential thrombolysis patients evaluated with transcranial Doppler (TCD) ultrasound and the NIHSS at the time of presentation were studied. TCD was performed using previously validated criteria for clot detection, localization, and subsequent degree of recanalization after thrombolysis. In patients treated at (0.9 mg/kg), repeat NIHSS scores and diagnostic TCD were performed at the end of infusion. Results: 119 ischemic stroke patients met inclusion criteria (age 68±15, NIHSS 15±7, median 14, range 2–36), with 83% having occlusion consistent with symptoms. Occlusion was present in all patients with NIHSS ≥22, none with NIHS