# Neglect scoring modifications in the National Institutes of Health Stroke Scale improve right hemisphere stroke lesion volume prediction

## TL;DR

This study shows that adjusting the NIHSS scoring for neglect improves its ability to predict stroke lesion volume in the right hemisphere.

## Contribution

The paper introduces modified NIHSS scoring rules for neglect that enhance lesion volume prediction in right hemisphere strokes.

## Key findings

- The standard NIHSS had lower correlation with lesion volume in patients with neglect compared to those without.
- Modifying the neglect scoring rules significantly improved the correlation between NIHSS and lesion volume.
- With modified scoring, neglect was no longer a significant covariate in the correlation analysis.

## Abstract

The National Institutes of Health Stroke Scale (NIHSS) does not equitably assess stroke severity in the two cerebral hemispheres. By attributing a maximum of two points for neglect and seven for language, it undervalues right hemisphere deficits. We aimed to investigate if NIHSS equally predicts right hemisphere lesion volumes in patients with and without neglect, and if a modification of the neglect scoring rules could increase its predictive capacity.

We analyzed a prospective cohort of acute right middle cerebral artery ischemic stroke patients. First, we calculated the correlation between NIHSS scores and lesion volume and analyzed the partial correlation of neglect. Then, we applied different modifications in the neglect scoring rules and investigated how they interfered with lesion volume predictive capacity.

A total of 162 ischemic stroke patients were included, 108 with neglect and 54 without. The correlation between lesion volume and NIHSS was lower in patients with neglect (r = 0.540 vs. r = 0.219, p = 0.004) and neglect was a statistically significant covariate in the partial correlation analysis between NIHSS and lesion volume (p = 0.017). With the neglect score tripled and with the duplication or triplication of all neglect modalities, the correlation was significantly higher than with the standard NIHSS (p = 0.043, p = 0.005, p = 0.001, respectively). With these modifications, neglect was no longer a significant covariable in the partial correlation between lesion volume and NIHSS.

A modification of NIHSS neglect scoring might improve the scale's capacity to predict lesion volume.

In this study, neglect was a statistically significant covariate in the partial correlation analysis between NIHSS and lesion volume. With different modifications of the neglect scoring rules, neglect was no longer a statistically significant factor. These results may increase the NIHSS predictive capacity of the lesion volume.