PENDAHULUANTo test the hypothesis that the National Institutes of Health Stroke Scale (NIHSS) score isassociated ith the findin!s of arterio!raphy perfor"ed ithin the first hours after ische"icstroke#NIHSSscoresin$asilar% internal carotid% and"iddlecere$ral artery&'and&(se!"ent occlusions (central occlusions) ere hi!her thanin"ore peripherallylocated%non)isi$le% ora$sent occlusions# PatientsithNIHSSscores*'+hadpositi)epredicti)e)alues(PP,s)toshoarterial occlusionsin-./ofcarotidand-0/of)erte$ro$asilarstrokes# 1ithanNIHSSscoreof *'(% PP,tofindacentral occlusionas -'/# Ina"ulti)ariate analysis% NIHSS su$ite"s such as 2le)el of consciousness 3uestions%4 2!a5e%42"otor le!%4 and 2ne!lect4 ere predictors of central occlusions# (6ischer)There is a si!nificant association of NIHSS scores and the presence and location of a )esselocclusion# 1ith an NIHSS score *'+% a )essel occlusion ill likely $e seen on arterio!raphy%and ith a score *'(% its location ill pro$a$ly $e central# (6ischer)Strokeis a"on!theleadin!causes of death% disa$ility% hospitali5ations% andhealthcaree7penditures in the United States# The National Institutes of Health Stroke Scale (NIHSS)%hich is a )alidated tool for assessin! the initial stroke se)erity% has $een shon to predict"ortality in acute ische"ic stroke in se)eral prior studies#-8'9 (:re!!)The NIHSS is a ';atin!s for each ite" are scored ith ? to ; !rades ith + asnor"al# (:re!!)TheNIHSSasde)elopedandsu$se3uently)alidatedasatool forassessin!theinitialstroke se)erity#(+%(' It has su$se3uently $een shon to $e predicti)e of a )ariety of strokefunctional outco"es#.8'+ Stroke se)erity as inde7ed $y NIHSS has also $een shon to $epredicti)e of "ortality after acute ische"ic stroke#-8'9 (:re!!)The NIHSSneurolo!icale7a"ination includes'; indi)idualele"entsthat "easure "otorandsensoryfunction% lan!ua!eandspeechproduction% )ision% le)el ofconsciousnessandattention% and ne!lect# The ele"ents are su""ed to pro)ide an o)erall assess"ent of strokese)erity% ith the score ran!in!fro" + to 9(# Stroke se)erity at onset has $een associatedith "ortality% functional disa$ility% len!th of hospital stay% and reco)ery#?%9 (Suchare)ISIThe National Institutes of Health Stroke Scale (NIHSS) is idely used to assess the se)erityof acute ische"ic stroke#' It has $een used in "any trials and is a )alidated tool to predictstroke outco"e#(80 Specifically% it has $een used in thro"$olysis trials to include or e7cludepatients fro" acti)e treat"ent#.8- (6ischer)Patients ith acute stroke and ithout )isi$le )essel occlusion or peripheral occlusions onintra) an!io!raphy and 9? patients ith DSAshoed an increasin! pro$a$ility to find )essel occlusions ith hi!her NIHSS scores#';%'0The presence of a sy"pto"atic cere$ral arterial occlusion "ay ha)e clinical i"plications fortreat"ent decisions% especiallyifintra>I>I>II>IS#'.Sykoraet al shoedthat C>Si"pair"ent dependsonthe)olu"eof thestrokeandin)ol)e"entof theinsula'0A theyconfir"theconclusions of>o$insonet al that C>S deterioration after stroke reflects centralautono"ic dysfunction#';Si"ilar to our results% Sykora et al found correlations $eteen decreasin! C>S and increasin!NIHSSscores#'->educed C>Sis associated ith poor outco"e in cardiac%renal% or"eta$olic diseases%9+%9? and in stroke#;%'; Accordin!to >o$inson et al% C>S i"pair"entdurin!acutestrokeisassociateditha9#;S# CP fluctuations orsen stroke outco"e% as theycause "ore se)ere end