WEDNESDAY, Dec. 15, 2021 (American Heart Association News) – A tool widely used by doctors to help determine who needs blood thinning treatment after stroke has parts missing, new research suggests that the addition of a few simple tests could help improve treatment for people with less common strokes in the back of the brain.
Published Wednesday in the American Heart Association’s Stroke Journal, the study shows that changing the National Institutes of Health’s Stroke Scale to include tests for symptoms that occur when people have circulatory strokes. posterior could identify more people with potentially debilitating symptoms requiring immediate treatment who may not get it.
“The current stroke scale that is widely used is biased towards anterior circulatory strokes, those involving the arteries supplying the front of the brain,” said Dr Amytis Towfighi, professor of neurology and population and public health sciences at the University of Southern California. Keck School of Medicine in Los Angeles. She was not involved in the new research. “It does not accurately represent the severity of posterior circulatory strokes because it does not test for the major deficits seen in these strokes.”
Posterior circulatory strokes occur in the back of the brain and are less common, accounting for about 1 in 5 ischemic strokes (caused by a clot). But people who have it are at a higher risk of having a serious stroke, becoming disabled, or dying.
The NIH Stroke Scale, considered the standard for assessing the severity of stroke, is used to identify a level of risk for post-stroke disability that helps determine who would benefit from so-called reperfusion treatments such as the medications used. to break up blood clots or non-invasive surgery to remove them. Doctors use the scale to rate and help determine treatment needed by using a series of tests to assess the potential severity of stroke symptoms.
But these tests focus on common symptoms of stroke, such as weakness in the arms and legs or difficulty speaking. People with a stroke in the back of the head, on the other hand, may experience additional problems with balance, dizziness, coordination, swallowing, or headaches.
Some of these symptoms are not assessed by the current stroke scale, said lead author of the study Dr Fana Alemseged, a neurologist and researcher in the Department of Medicine and Neurology at Royal Melbourne Hospital in Australia. .
As a result, people with posterior stroke score lower on the rating scale, suggesting that they do not need reperfusion therapy. But, she said, “Time is the brain! About 2 million neurons die every minute. Thus, withholding or delaying treatment due to an inaccurate clinical assessment could lead to long-term disability. in patients with stroke. “
Permanent brain damage can occur if the blood supply is not restored to the brain, Alemseged said. “Patients with posterior circulatory stroke not treated with reperfusion therapy may have residual symptoms such as limb weakness and speech problems, visual disturbances, memory problems, problems with speech. coordination or balance and difficulty swallowing that may affect their activities of daily living. “
Preliminary research presented at the AHA’s International Stroke Conference earlier this year found that people with posterior stroke are much less likely to receive treatment to dissolve or remove clots than those who have. suffered a stroke in the front of the brain.
The new study found that people with posterior circulatory stroke who scored low on the stroke scale were more likely to be disabled than people with previous circulatory strokes – showing that up to 40% of these patients suffer from disabilities that persist at three months.
Alemseged and his team modified the NIH Stroke Scale to include ratings for difficulty with balance or walking and problems with coughing or swallowing.
In the study, people who could stand were asked to do so for a few seconds and then walk naturally. If they had muscle weakness, the balance was tested by asking them to sit in bed and seeing if they were able to do so without assistance.
Towfighi said people with stroke are not routinely tested for balance issues due to safety concerns because they may be too weak to stand or could fall.
“It’s a little difficult to test balance in an acute setting,” said Towfighi, who is also head of the neurology department and associate medical director of research at Los Angeles County + USC Medical Center.
Alemseged’s research used the new modified model to assess patients who scored low on the traditional scale following posterior stroke and found that 17% of them (36 of 213 people) would potentially not have been considered for treatment even if they had any disabling symptoms. Alemseged said more and larger studies are needed to confirm his team’s results.
Towfighi said it was high time to find a way to identify people with posterior stroke who need treatment.
“We have been using this scale for over 20 years,” she said, “and people have recognized the limitation for years. This research provides simple, straightforward tests that have the potential to improve results in dozens of patients. “
American Heart Association News covers heart and brain health. Any opinions expressed in this story do not reflect the official position of the American Heart Association. Copyright is owned or owned by the American Heart Association, Inc., and all rights are reserved. If you have any questions or comments on this story, please email [email protected].
By Laura Williamson