Sains Malaysiana 49(5)(2020): 1115-1120

http://dx.doi.org/10.17576/jsm-2020-4905-16

Correlation between Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) and National Institute of Health Stroke Score (NIHSS) in Ischemic Stroke

(Korelasi antara Skor Awal Tomografi Berkomputer Program Strok Alberta (ASPECTS) dan Skor Strok Institut Kesihatan Nasional (NIHSS) pada Strok Iskemik)

LISDA AMALIA¹*, MARDA ARIF FURQANI¹, IDA PARWATI², AHMAD RIZAL¹ & RAMDAN PANIGORO³

¹Department of Neurology, University of Padjadjaran/Hasan Sadikin, General Hospital Bandung, Indonesia

²Department of Clinical Pathology, University of Padjadjaran/Hasan Sadikin, General Hospital Bandung, Indonesia

³Department of Basic Medical Science, University of Padjadjaran/Hasan Sadikin, General Hospital Bandung, Indonesia

Diserahkan: 17 September 2018/ Diterima: 21 Januari 2020

ABSTRACT

Computed tomography scanning (CT-scan) hold an important role in diagnosing ischemic stroke, but may find difficulties to assess an early ischemic changes. ASPECTS provide a tool for assessing CT-scan in ischemic stroke, which can be used as predictor of stroke outcome. Stroke outcome and severity can also be assessed using NIHSS. We hypothesize that ASPECT score had negative correlation with neurological deficit in patient with acute ischemic stroke compared with non-contrast head CT scan. This was an analytic-descriptive cross-sectional study on first-onset ischemic stroke patient in Neurology Ward of Hasan Sadikin General Hospital admitted from October 2017 – February 2018. ASPECTS was calculated from CT-scan of ischemic stroke patients involving medial cerebral artery and compared to NIHSS. From 58 subject (44.8% male, 55.2%) female), with mean age 56.60+ 9.1 years, there were 58.6% subject with lacunar stroke, 20.7% with large artery atherosclerotic (LAA) stroke, and 20.7% with cardioemboli stroke. Subjects with LAA stroke and lacunar stroke had higher ASPECTS (p value < 0.05) and had lower NIHSS (p value < 0.05) than subjects with cardioembolic stroke. Spearman’s correlation test between ASPECTS and NIHSS show a strong correlation between ASPECTS and NIHSS (r=-0.680, p<0.001). There was a strong inverse correlation between ASPECTS and NIHSS score on acute ischemic stroke. The higher the value of ASPECTS, the lower the value will be for NIHSS and ASPECT score had correlation with stroke severity.

Keywords: ASPECTS; ischemic stroke; NIHSS

ABSTRAK

Pengimbasan tomografi berkomputer (skan CT) memainkan peranan penting dalam mendiagnosis strok iskemia, tetapi mungkin menghadapi kesukaran untuk menilai perubahan awal iskemia. ASPECTS menyediakan alat untuk menilai skan CT pada strok iskemia, yang boleh digunakan sebagai peramal kesan strok. Kesan dan keparahan strok juga dapat dinilai menggunakan NIHSS. Kami membuat hipotesis bahawa skor ASPECT mempunyai korelasi negatif dengan defisit neurologi pada pesakit dengan strok iskemia akut berbanding dengan skan CT kepala tanpa kontras. Ini adalah kajian keratan rentas analitik-deskriptif pada pesakit strok iskemia pertama di Wad Neurologi Hospital Umum Hasan Sadikin yang diterima dari Oktober 2017 - Februari 2018. ASPECTS dihitung daripada skan CT pesakit strok iskemia yang melibatkan arteri serebrum medial dan dibandingkan kepada NIHSS. Daripada 58 subjek (44.8% lelaki, 55.2%) wanita), dengan min usia 56.60+ 9.1 tahun, terdapat 58.6% subjek dengan strok lakunar, 20.7% dengan strok aterosklerotik arteri besar (LAA) dan 20.7% dengan strok kardioemboli. Subjek dengan strok LAA dan lakunar mempunyai ASPECTS yang lebih tinggi (nilai p <0,05) dan mempunyai NIHSS yang lebih rendah (nilai p <0,05) daripada subjek dengan strok kardioemboli. Ujian korelasi Spearman antara ASPECTS dan NIHSS menunjukkan korelasi yang kuat antara ASPECTS dan NIHSS (r = -0.680, p <0.001). Terdapat korelasi berbalik yang kuat antara skor ASPECTS dan NIHSS pada strok iskemia akut. Semakin tinggi nilai ASPECTS, semakin rendah nilainya untuk NIHSS dan skor ASPECT mempunyai hubungan dengan keparahan strok.

Kata kunci: ASPECTS; NIHSS; strok iskemia

RUJUKAN

Alfa, A.Y. 2010. Penatalaksanaan Stroke Fase Akut. In Neurology in Daily Practice, edited by Basuki, A. & Dian, S. 1st ed. Bandung: Bagian/UPF Ilmu Penyakit Saraf Fakultas Kedokteran UNPAD/RS. Hasan Sadikin. pp. 67-84.

Arboix, A. & Alió, J. 2010. Cardioembolic stroke: Clinical features, specific cardiac disorders and prognosis. Current Cardiology Reviews 6(3): 150-161.

Glymour, M.M., Berkman, L.F., Ertel, K.A., Fay, M.E., Glass, T.A. & Furie, K.L. 2007. Lesion characteristics, NIH stroke scale, and functional recovery after stroke. American Journal of Physical Medicine & Rehabilitation 86(9): 725-733.

Hacke, W., Donnan, G., Fieschi, C., Kaste, M., von Kummer, R., Broderick, J.P., Brott, T., Frankel, M., Grotta, J.C., Haley, E.C., Kwiatkowski, T., Levine, S.R., Lewandowski, C., Lu, M., Lyden, P., Marler, J.R., Patel, S., Tilley, B.C., Albers, G., Bluhmki, E., Wilhelm, M., Hamilton, S., ATLANTIS Trials Investigators. & ECASS Trials Investigators. 2004. Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411): 768-774.

Hill, M.D. & Buchan, A.M. 2005. Thrombolysis for acute ischemic stroke: Results of the Canadian alteplase for Stroke Effectiveness Study. Canadian Medical Association Journal 172(10): 1307-1312.

Horie, N., Tateishi, Y., Morikawa, M., Morofuji, Y., Hayashi, K., Izumo, T., Tsujino, A., Nagata, I. & Matsuo, T. 2016. Acute stroke with major intracranial vessel occlusion: Characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion. Journal of Clinical Neuroscience 32: 24-29.

Kim, B.J. & Kim, J.S. 2014. Ischemic stroke subtype classification: An Asian viewpoint. Journal of Stroke 16(1): 8-17.

Mansour, O.Y., Megahed, M.M. & Abd Elghany, E.H.S. 2015. Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS scale and full outline of unresponsiveness score in intensive care unit. Alexandria Journal of Medicine 51(3): 247-253.

Menon, B.K., Puetz, V., Kochar, P. & Demchuk, A.M. 2011. ASPECTS and other neuroimaging scores in the triage and prediction of outcome in acute stroke patients. Neuroimaging Clinics of North America 21(2): 407-423.

Meschia, J.F., Bushnell, C., Boden-Albala, B., Braun, L.T., Bravata, D.M., Chaturvedi, S., Creager, M.A., Eckel, R.H., Elkind, M.S., Fornage, M., Goldstein, L.B., Greenberg, S.M., Horvath, S.E., Iadecola, C., Jauch, E.C., Moore, W.S. & Wilson, J.A. 2014. Guidelines for the primary prevention of stroke. A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(12): 3754-3832.

Misbach, J. & Ali, W. 2000. Stroke in Indonesia: A first large prospective hospital-based study of acute stroke in 28 hospitals in Indonesia. Journal of Clinical Neuroscience 8(3): 24524-24529.

Puetz, V., Dzialowski, I., Hill, M.D. & Demchuk, A.M. 2009. The Alberta Stroke Program early CT score in clinical practice: What have we learned? International Journal of Stroke 5: 354-364.

*Pengarang untuk surat-menyurat; email: dr.lisda@gmail.com