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Historic Stroke Motor Severity Score Predicts Progression in TIA/Minor Stroke

Published online by Cambridge University Press:  23 September 2014

Marie-Christine Camden ,
Michael D. Hill ,
Andrew M. Demchuk ,
Alexandre Y. Poppe ,
Nan Shobha ,
Philip A. Barber  and
Shelagh B. Coutts
Marie-Christine Camden
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Departement des Sciences Neurologiques, CHU (Enfant-Jesus), Laval University, Quebec City, Quebec, Canada
Michael D. Hill
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Radiology, University of Calgary Community Health Sciences and Medicine, University of Calgary Hotchkiss Brain Institute, University of Calgary
Andrew M. Demchuk
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Radiology, University of Calgary Hotchkiss Brain Institute, University of Calgary
Alexandre Y. Poppe
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Notre-Dame Hospital, Centre hospitalier de l’Universite de Montreal
Nan Shobha
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Bangalore Neuro Centre, Bangalore, India
Philip A. Barber
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Radiology, University of Calgary Hotchkiss Brain Institute, University of Calgary
Shelagh B. Coutts*
Affiliation:
Departments of Clinical Neurosciences, University of Calgary Radiology, University of Calgary Hotchkiss Brain Institute, University of Calgary
*
Foothills Hospital, C1261, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada. Email: scoutts@ucalgary.ca.
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Abstract

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Background:

transient ischemic attack (tIA) and minor stroke have a high risk of early neurological deterioration, and patients who experience early improvement are at risk of deterioration. We generated a score for quantifying the worst reported motor and speech deficits and assessed whether this predicted outcome.

Methods:

510 tIA or minor stroke (NIHSS>4) patients were included. the Historical Stroke Severity Score (HSSS) prospectively quantified the patient's description of the worst motor or speech deficits. the HSSS was rated at the time of first assessment with more severe deficits scoring higher. Motor HSSS included assessments of arm and leg motor power (score total 0-5). Speech HSSS assessed severity of dysarthria and aphasia (total 0-3). the association between motor and speech HSSS and symptom progression was assessed during the 90-day follow-up period.

Results:

the proportion of patients in each category of the motor HSSS was 0: 43% (216/510), 1: 22%(110/510), 2: 17% (89/510), 3: 7% (37/510), 4: 5% (28/510) and 5: 6% (30/510). Motor HSSS was associated with symptom progression (p=0.004) but not recurrent stroke. Speech HSSS was not associated with either progression or recurrent stroke. Motor HSSS predicted disability (p=0.002) and intracranial occlusion (p=0.012). Disability increased with increasing motor HSSS.

Conclusions:

taking a detailed history about the severity of motor deficits, but not speech, predicted outcome in tIA and minor stroke patients. A score based on the patient's description of the severity of motor symptoms predicted symptom progression, intracranial occlusion and functional outcome, but not recurrent stroke in a tIA and minor stroke population.

Résumé

RÉSUMÉ

Le Historical Stroke Severity Score moteur prédit la progression d’un accès ischémique cérébral transitoire / d’un accident vasculaire cérébral mineur.

Contexte:

L’acces ischemique cerebral transitoire (ICt) et l’accident vasculaire cerebral mineur (AvCM) comportent un risque eleve de deterioration neurologique precoce et les patients chez qui on observe une amelioration precoce sont a risque de deterioration. Nous avons elabore un score pour quantifier les pires deficits moteurs et du langage rapportes et nous avons evalue si ceci predisait l’issue.

Méthode:

Cinq cent dix patients atteints d’une ICt ou d’un AvCM (NIHSS < 4) ont ete inclus dans l’etude. Le Historical Stroke Severity Score (HSSS) a servi a quantifier prospectivement la description du pire deficit moteur ou du langage que le patient avait presente. Le HSSS a ete evalue au moment du premier examen que le patient a subi, les deficits plus severes recevant un score plus eleve. L’evaluation motrice du HSSS incluait des evaluations de la force motrice des bras et des jambes (score total 0 a 5). Le HSSS evaluait la severite de la dysarthrie et de l’aphasie (total 0 a 3). L’association entre le score moteur et celui du langage au HSSS et la progression des symptomes ont ete evaluees au cours de la periode de suivi de 90 jours.

Résultats:

La proportion de patients dans chaque categorie du HSSS moteur etait 0 : 43% (216/510), 1 : 22% (110/510), 2 : 17% (89/510), 3 : 7% (37/510), 4 : 5% (28/510) et 5 : 6% (30/510). Le score HSSS moteur etait associe a la progression des symptomes (p = 0,004) mais il n’etait pas associe a un deuxieme AvC. Le HSSS du langage n’etait pas associe a la progression ou a un deuxieme AvC. Le HSSS moteur predisait l’invalidite (p = 0,002) et l’occlusion intracranienne (p = 0,012). L’invalidite augmentait avec l’augmentation du HSSS moteur.

Conclusions:

Une histoire detaillee sur la severite des deficits moteurs predisait l’issue chez les patients presentant une ICt ou un AvC mineur, ce qui n’etait pas le cas pour les deficits du langage. Un score fonde sur la description faite par le patient de la severite des symptomes moteurs predisait la progression des symptomes, l’occlusion intracranienne et l’issue fonctionnelle, mais non un AvC subsequent chez des patients presentant une ICt ou un AvCM.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 1 , January 2014 , pp. 19 - 23
Copyright
Copyright © The Canadian Journal of Neurological 2014

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