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NIH stroke scale (NIHSS) assessment is crucial in Telestroke. However, certain NIHSS items demonstrated poor reliability when assessed remotely. We aimed to develop a modified remote version of the NIHSS (rNIHSS) for caregiver-assisted telestroke assessments. We evaluated 102 stroke patients. A neurologist conducted the NIHSS assessment remotely via smartphone, assisted by caregivers, and followed by bedside evaluation by another neurologist. The agreement for total NIHSS scores and each individual item was tested. The rNIHSS was developed by excluding unreliable items, followed by evaluation of its reliability and validity. Caregiver-assisted remote NIHSS assessments demonstrated limited reliability (84.3 % agreement). The rNIHSS was developed by excluding items with poor wK values: visual field, facial palsy, extinction/inattention, and ataxia. Remote rNIHSS assessments in mild stroke cases were equivalent to bedside assessments, with 98.2 % of the subjects having total scores that differed by ≤ 2 points; however, the reliability was limited in moderate and severe strokes (93.1 % and 77.8 % agreement, respectively). The correlation coefficients for the rNIHSS scores and bedside NIHSS scores, and the 90-day and 1-year modified Rankin scale scores were 0.97, 0.88, and 0.86, respectively (p < 0.01). Caregiver-assisted rNIHSS remote assessment improved reliability in mild stroke patients but was limited in severe cases. Prospective validation of the rNIHSS is needed. •Our remote NIHSS assessment study focused on caregiver assistance. The rNIHSS, developed by excluding unreliable items in remote assessments, showed better reliability than the original NIHSS but remains unreliable in severe stroke patients when assessed remotely.•To our knowledge, this modified rNHISS for telestroke assessments has not been previously proposed.

Introduction: thrombolytic therapy is the primary saving measure adopted in ischemic cerebrovascular accident (ICVA) victims, adequate for most of them. However, some patients do not show clinical progress, worsening the prognosis, which constitutes an essential scientific gap. Objective: to analyze the determinants of clinical non-improvement in stroke patients who used rt-PA thrombolytic agentes. Methods: retrospective observational case-control study, carried out from 2014 to 2017 through an active search of medical records of CVA patients undergoing thrombolytic therapy in a reference hospital in Ceará. Clinical failure was characterized as no reduction in the National Institutes of Health Stroke Scale-Score (NIHSS). Results: a total of 139 patients enrolled in the study in a single CVA unit. The mean age was 66.14 years (range 34 to 95). The 24-hour follow-up was completed in 100% of patients. A favorable result 24 hours post-thrombolysis was observed in 113 patients (81.29%), and there was no clinical improvement in 26 (18.7%). Post-thrombolysis hemorrhagic transformation was a strong predictor of no improvement (p=0.004), and diabetes was the main modifiable risk factor found (p=0.040). Conclusion: diabetes and hemorrhagic transformation after thrombolysis were identified as risk factors for clinical non-improvement in patients with acute stroke undergoing thrombolytic therapy.

Background Optimal management of patients with large vessel occlusion (LVO) and low NIHSS score is unknown, which was the aim to investigate in this study. Methods This is a retrospective analysis of a prospective single tertiary care centre 14-year cohort of patients with LVO in the anterior circulation and NIHSS score ≤ 5 on admission. Outcome was analysed according to primary intended therapy. Results Among 185 patients (median age 67.4 years), 52.4% received primary conservative therapy (including 26.8% secondary reperfusion in case of secondary neurological deterioration), 12.4% IV thrombolysis (IVT) only and 35.1% primary endovascular therapy (EVT). 95 (51.4%) patients experienced neurological deterioration until 3 months. Primary-IVT-only and primary-EVT compared to conservative-therapy patients had better 3 months’ outcome (54.5% vs. 30.8%: adjusted OR 6.02; adjusted p  = 0.004 for mRS 0–1 and 54.7% vs. 30.8%: adjusted OR 5.09; adjusted p  = 0.002, respectively). Also mRS shift analysis favored primary-IVT-only and primary-EVT patients ( adjusted OR 6.25; adjusted p  = 0.001 and adjusted OR 3.14; adjusted p  = 0.003). Outcome in primary-IVT-only vs. primary-EVT patients did not differ significantly. Patients who received secondary EVT because of neurological deterioration after primary-conservative-therapy had worse 3 months’ outcome than primary-EVT patients (20.8% vs. 30.8%: adjusted OR 0.24; adjusted p  = 0.047 for mRS 0–1 and adjusted OR 0.31; adjusted p  = 0.019 in mRS shift analysis). Survival and symptomatic intracranial haemorrhage did not differ amongst groups. Conclusions Our data indicate that primary IVT and/or EVT may be better than primary conservative therapy in patients with LVO in the anterior circulation and low NIHSS score. Furthermore, primary EVT was better than secondary EVT in case of neurological deterioration. There is an unmet need for RCTs to find the optimal therapy for this patient group.

Stroke is a disease associated with high mortality. Many inflammatory indicators such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and red blood cell distribution width (RDW) have been documented to predict stroke prognosis, their predictive power is limited. A novel inflammatory indicator called systemic inflammatory response index (SIRI) has been advocated to have an essential role in the prognostic assessment of cancer and infectious diseases. In this study, we attempted to assess the prognosis of stroke by SIRI. Moreover, we compared SIRI with other clinical parameters, including NLR, PLR, LMR and RDW. This was a retrospective cohort study. We obtained data of 2450 stroke patients from the Multiparametric Intelligent Monitoring in Intensive Care III database. We used the Cox proportional hazards models to evaluate the relationship between SIRI and all-cause mortality and sepsis. Receiver operating curve (ROC) analysis was used to assess the predictive power of SIRI compared to NLR, PLR, LMR and RDW for the prognosis of stroke. We collected data of 180 patients from the First Affiliated Hospital of Wenzhou Medical University, which used the Pearson's correlation coefficient to assess the relationship between SIRI and the National Institute of Health stroke scale (NIHSS). After adjusting multiple covariates, we found that SIRI was associated with all-cause mortality in stroke patients. Rising SIRI accompanied by rising mortality. Besides, ROC analysis showed that the area under the curve of SIRI was significantly greater than for NLR, PLR, LMR and RDW. Besides, Pearson's correlation test confirmed a significant positive correlation between SIRI and NIHSS. Elevated SIRI was associated with higher risk of mortality and sepsis and higher stroke severity. Therefore, SIRI is a promising low-grade inflammatory factor for predicting stroke prognosis that outperformed NLR, PLR, LMR, and RDW in predictive power.

To determine whether differences in lymphocyte-related inflammatory markers in the ultra-early phase of stroke (within 24 hours of onset) are associated with post-stroke cognitive impairment in the early recovery phase (within 30 days of stroke onset), and to further assess the predictive value of these markers. The study population consisted of patients who underwent rehabilitation treatment at the Rehabilitation Department of Hebei University Affiliated Hospital between December 2024 and June 2025, within 30 days of stroke onset, ie, during the early recovery phase of stroke. Patients were grouped based on whether they developed cognitive impairment. A retrospective analysis was conducted of patients' blood markers and neurological deficit scores within 24 hours of stroke onset to examine the relationship between ultra-early blood markers and neurological deficits and post-stroke cognitive impairment. There were no significant differences in baseline data between the two groups. However, the proportion of hemorrhagic stroke patients was significantly higher in the PSCI group than in the non-PSCI group (39.7% vs 18.8%, P=0.026<0.05). NLR and NIHSS scores showed significant differences between the two groups. Multivariate analysis indicated that NIHSS (OR=1.297, 95% CI: 1.167-1.442, p<0.001) was independently associated with PSCI, while NLR (OR=1.107, 95% CI: 0.995-1.231, p=0.063) showed a borderline association with PSCI. MLR showed differences between the two groups in univariate analysis (P=0.018) but was excluded in multivariate analysis. ULR did not show significant differences. NIHSS is a strong predictive factor (P < 0.05), with a cut of value of 12 calculated by the ROC curve. NLR is at the threshold for an independent risk factor. Subsequent ROC curves indicate that NLR has low diagnostic sensitivity but high specificity, making it more suitable for screening rather than diagnostic use. MLR and ULR did not demonstrate high predictive value; further studies should be conducted to expand the sample size, perform subgroup analyses, and increase follow-up.

•Multicenter study evaluating the impact of COVID-19 pandemic on ischemic stroke volumes, subtypes, and clinical presentation in US.•Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes, LVOs, and IV-tPA administration.•Patients admitted to the hospital had severe disease (NIHSS>14) and were more likely to discharge home. To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0−7), moderate [8–14], and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition. Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 ± 3 vs 50 ± 20,p = 0.003), LVOs (16.5 ± 3.8 vs 8.3 ± 5.9,p = 0.008), and IV-tPA (10.9 ± 3.4 vs 5.3 ± 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % ±5 vs 16 % ±7,p = 0.24) and IV-tPA (10.4 % ±4.5 vs. 9.9 % ±2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS > 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07–1.49,p = 0.016). During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.

Background 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. Methods 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. Results 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. Conclusion 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.

Background Stroke is the most significant cause of death and disability around the world. It is the second leading cause of death after cardiovascular disease. Currently, the triglyceride–glucose (TyG) index has proven to be a reliable surrogate indicator of IR in stroke studies. However, the relationship between TyG and poor functional outcomes in patients with ischemic stroke remains unclear. Accordingly, this study aimed to explore the relationship between TyG index and clinical outcomes at 3 months after acute ischemic stroke (AIS). Methods The clinical data of 564 AIS patients admitted to the Second People's Hospital of Hefei from January 2020 to September 2024 were collected. According to the mRS score at 3 months after onset, the patients were divided into a poor functional prognosis group and a good functional prognosis group. Univariate and multivariate logistic regression models were used to explore the correlation between the TyG index at admission and the 3‐month functional prognosis of AIS patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the TyG index and the TyG index combined with the admission NIHSS score (TyG‐NIHSS) for the 3‐month functional prognosis of AIS patients. Results A total of 564 AIS patients were included, with 165 cases (29.25%) in the poor functional prognosis group and 399 cases (70.75%) in the good functional prognosis group. Multivariate logistic regression analysis showed that systolic blood pressure at admission, NIHSS score, and TyG index were independent risk factors for poor functional prognosis at 3 months in AIS patients (p < 0.05). The higher the TyG index, the higher the risk of poor functional prognosis at 3 months (OR = 3.18, 95% CI: 2.252–4.499, p < 0.001). ROC curve analysis showed that the area under the curve (AUC) for the TyG index to predict poor functional prognosis at 3 months in AIS patients was 0.650 (95% CI: 0.598–0.702, p < 0.001), with a sensitivity of 61.2% and a specificity of 62.7%. The AUC for TyG‐NIHSS to predict poor functional prognosis at 3 months in AIS patients was 0.836 (95% CI: 0.799–0.873, p < 0.001), with a sensitivity of 80.6% and a specificity of 76.7%. Conclusion The TyG index is an independent but moderate predictor of poor outcomes at 3 months poststroke. However, TyG‐NIHSS represents a highly discriminative multivariate model. This model demonstrates good predictive ability and high predictive accuracy. A high triglyceride–glucose (TyG) index is an independent risk factor for poor functional outcome at 3 months in patients with acute ischemic stroke (AIS). The predictive accuracy of the combined TyG‐NIHSS model for a poor 3‐month outcome was significantly higher than that of the TyG index alone .

Brain electrical activity in acute ischemic stroke is related to the hypoperfusion of cerebral tissue as manifestation of neurovascular coupling. EEG could be applicable for bedside functional monitoring in emergency settings. We aimed to investigate the relation between hyper-acute ischemic stroke EEG changes, measured with bedside wireless-EEG, and hypoperfused core-penumbra CT-perfusion (CTP) volumes. In addition, we investigated the association of EEG and CTP parameters with neurological deficit measured by NIHSS. We analyzed and processed EEG, CTP and clinical data of 31 anterior acute ischemic stroke patients registered within 4.5 h from symptom onset. Delta/alpha ratio (DAR), (delta + theta)/(alpha + beta) ratio (DTABR) and relative delta power correlated directly (ρ = 0.72; 0.63; 0.65, respectively), while alpha correlated inversely (ρ = − 0.66) with total hypoperfused volume. DAR, DTBAR and relative delta and alpha parameters also correlated with ischemic core volume (ρ = 0.55; 0.50; 0.59; − 0.51, respectively). The same EEG parameters and CTP volumes showed significant relation with NIHSS at admission. The multivariate stepwise regression showed that DAR was the strongest predictor of NIHSS at admission (p < 0.001). The results of this study showed that hyper-acute alterations of EEG parameters are highly related to the extent of hypoperfused tissue highlighting the value of quantitative EEG as a possible complementary tool in the evaluation of stroke severity and its potential role in acute ischemic stroke monitoring.