How to evaluate a patient with stroke?

1. Gastroepato
2. Neurology
3. How to evaluate a patient with stroke
4. Hemorrhagic stroke
5. Occlusive pathology of cerebral arteries
6. Neuronal damage

Notes by dr Claudio Italiano

What is NIHSS and what is it for?

• The scale of the National Institute of Health (NIH) is universally used in everyday clinical practice and in research to quantify the severity of the neurological deficit caused by an acute cerebral stroke.

• It consists of 11 items and the total score goes from a minimum of 0 = normal neurological examination
at a maximum of 42, severe neuro-sensory-motor deficit.

Why use a score?

Because there is so much confusion about how a patient should be visited and it is advisable to standardize the methodology of the patient's bedside diagnosis. At the end of the compilation, the score gives us an idea about the patient's clinical status and, in a certain sense, about the severity of the signs and of the prognosis. Good is the score of 80% that is a scouring <14 points, while bad an evaluation> 22, which is in 20% of the subjects. One of the limitations is the poor capacity for evaluating consciousness and dysarthria; besides it investigates little on the cranial nerves and has little sensitivity and specificity as a test for the cerebellar and trunk lesions. Let's see the point, by point, which are the items.

You can evaluate a patient using an assessment scale, called NIHSS, of which there is an Italian version, edited by the Department of Neurological Sciences of Sapienza of Rome and by the Public Health Agency of the Lazio region in 2003. Certification of the correct use of the scale is obtained by passing the simulated patient evaluation test, also online

State of consciousness

• 0. Vigile: promptly respond to stimuli
• 1. Soporoso: awakening with minimal stimulation to execute orders, to respond or to react.
• 2. Stuporous: requires repeated stimulations or a painful stimulus to perform movements
• 3. Coma: responds only with motor or automatic reflexes, or is totally non-responsive, flaccid areflexic

1b Orientation (Consciousness), for example, ask for age and month

• 0. Correctly answer both questions
• 1. Respond correctly to a single question
• 2. It does not correctly answer any question
• If the patient is aphasic or stupor = score of 2
• Assign 1 if intubated or severe dispar

1c. Execution of simple orders (Conscience), ask for example to open and close the eyes and to open and close the hand

• 0. Performs both orders correctly
• 1. Performs only one order correctly
• 2. It does not correctly execute either order

2 . Horizontal look, ie the patient is asked to move his eyes horizontally, for example by following the tip of the doctor's hand

0. Normal
• 1. Partial paralysis of the gaze (when the gaze is abnormal in one or both eyes, but the forced deviation of the gaze or the total paralysis is not present)
• 2. Forced or total deviation (paralysis of the gaze not exceeded by the oculocephalic maneuver)

3. Visual Field

• 0. No visual loss
• 1. Partial hemianopia
• 2. Complete hemianopsia