In a new study from Royal Melbourne Hospital, researchers found a tool widely used by doctors to help determine who needs clot-busting therapy after a stroke has some missing pieces.
They suggest that adding a few simple tests could help improve treatment for people who have less common strokes in the back of the brain.
The study shows modifying the National Institutes of Health Stroke Scale to include tests for symptoms that occur when people have posterior circulation strokes could identify more people with potentially disabling symptoms.
Posterior circulation strokes occur in the back of the brain and are less common, accounting for roughly 1 in 5 ischemic (clot-caused) strokes. But people who have them are at higher risk of severe stroke, becoming disabled or dying.
The NIH Stroke Scale, considered the standard for evaluating stroke severity, is used to identify a level of risk for post-stroke disabilities that helps determine who would benefit from drugs used to break up blood clots or non-invasive surgery to remove them.
Doctors use the scale to assess and help determine what treatment is needed using a series of tests to gauge the potential severity of stroke symptoms.
But those tests focus on symptoms common in front-of-the-head strokes, such as weakness in the arms and legs or trouble speaking.
People with back-of-the-head strokes, on the other hand, may experience additional problems with balance, dizziness, coordination, swallowing or headache.
As a result, people with posterior strokes end up with lower scores on the assessment scale that suggest they don’t need reperfusion therapies.
Patients with posterior circulation stroke not treated with reperfusion therapies can have residual symptoms such as limb weakness and speech problems, visual disturbances, memory issues, coordination or balance problems and difficulty swallowing that can affect their activities of daily living.
The new study found people with posterior circulation strokes who scored low on the stroke scale were more likely to be disabled than people with anterior circulation strokes – showing that up to 40% of those patients experience lingering disabilities at three months.
In the study, the team modified the NIH Stroke Scale to include assessments for balance or walking difficulties and problems coughing or swallowing.
They used the new modified model to assess patients who scored low on the traditional scale following posterior strokes and found 17% of them (36 people out of 213) would potentially not have been considered for treatment even though they had possible disabling symptoms.
The team says finding a way to identify people with posterior strokes who need treatment is long overdue.
This research provides simple straightforward tests which have the potential of enhancing outcomes in scores of patients.
If you care about stroke, please read studies about brain problem that can increase risk of stroke for up to five years, and findings of common drug that is effective for preventing recurrent heart problems and strokes.
For more information about brain health, please see recent studies about 5 critical steps to help prevent a stroke, and results showing 7 facts women should know to prevent and recognize stroke.
The study is published in Stroke. One author of the study is Dr. Fana Alemseged.
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