Neuroradiology · 2026
Beyond the total NIHSS score: association between impaired level of consciousness and early neurological deterioration in mild large vessel occlusion stroke.
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Ji Qiangze, Sun Liangliang, Liu Zenghui, Zhao Hanqing, Yu Jing, Zhang Ying, Duan Kaiyue, Guo Lili, Zhang Qiuyi
Аннотация
OBJECTIVE: To evaluate the association between baseline level of consciousness (LOC), measured by National Institutes of Health Stroke Scale (NIHSS) item 1a, and early neurological deterioration (END) in patients with mild anterior circulation large vessel occlusion (LVO) stroke (NIHSS < 6) treated with medical management.
METHODS: Consecutive patients were retrospectively included between January 2019 and December 2024. END was defined as an increase of ≥ 4 points in the NIHSS score within 24 h after symptom onset, attributable to ischemic causes. Multivariable logistic regression analysis was performed to identify factors associated with END.
RESULTS: A total of 247 patients were included, of whom 53 (21.5%) developed END. The incidence of END increased stepwise with worsening baseline LOC, occurring in 15.2%, 41.7%, and 63.2% of patients with NIHSS item 1a scores of 0, 1, and 2, respectively (P for trend < 0.001). After multivariable adjustment, NIHSS item 1a score 1 (adjusted odds ratio [aOR] 2.21, 95% confidence interval [CI] 1.05-4.63) and score 2 (aOR 3.76, 95% CI 1.42-9.97), larger Tmax > 6 s volume (per 20-mL increase; aOR 1.19, 95% CI 1.08-1.44), and internal carotid artery occlusion (aOR 2.34, 95% CI 1.02-5.38) were associated with END. Receiver operating characteristic analysis yielded areas under the curve of 0.760 and 0.828 for NIHSS item 1a thresholds of ≥ 1 and 2, respectively, in predicting END.
CONCLUSION: In medically managed mild LVO stroke, impaired LOC was associated with an increased risk of END, highlighting its potential as a complementary bedside indicator.
METHODS: Consecutive patients were retrospectively included between January 2019 and December 2024. END was defined as an increase of ≥ 4 points in the NIHSS score within 24 h after symptom onset, attributable to ischemic causes. Multivariable logistic regression analysis was performed to identify factors associated with END.
RESULTS: A total of 247 patients were included, of whom 53 (21.5%) developed END. The incidence of END increased stepwise with worsening baseline LOC, occurring in 15.2%, 41.7%, and 63.2% of patients with NIHSS item 1a scores of 0, 1, and 2, respectively (P for trend < 0.001). After multivariable adjustment, NIHSS item 1a score 1 (adjusted odds ratio [aOR] 2.21, 95% confidence interval [CI] 1.05-4.63) and score 2 (aOR 3.76, 95% CI 1.42-9.97), larger Tmax > 6 s volume (per 20-mL increase; aOR 1.19, 95% CI 1.08-1.44), and internal carotid artery occlusion (aOR 2.34, 95% CI 1.02-5.38) were associated with END. Receiver operating characteristic analysis yielded areas under the curve of 0.760 and 0.828 for NIHSS item 1a thresholds of ≥ 1 and 2, respectively, in predicting END.
CONCLUSION: In medically managed mild LVO stroke, impaired LOC was associated with an increased risk of END, highlighting its potential as a complementary bedside indicator.