Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke
Background: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess stroke severity. While prior studies have identified subcortical regions where infarcts correlate with NIHSS scores, stroke symptoms can also arise from hypoperfusion, not just infarcts. Understanding the pot...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | NeuroImage: Clinical |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213158225000312 |
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| author | Hana Kim Alex Teghipco Chris Rorden Julius Fridriksson Mathew Chaves Argye E. Hillis |
| author_facet | Hana Kim Alex Teghipco Chris Rorden Julius Fridriksson Mathew Chaves Argye E. Hillis |
| author_sort | Hana Kim |
| collection | DOAJ |
| description | Background: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess stroke severity. While prior studies have identified subcortical regions where infarcts correlate with NIHSS scores, stroke symptoms can also arise from hypoperfusion, not just infarcts. Understanding the potential for neurological recovery post-reperfusion is essential for guiding treatment decisions. The goal of this study was to identify brain regions where hypoperfusion correlates with NIHSS scores, using computed tomography perfusion (CTP) scans in cases of acute ischemic stroke. Methods: In this prospective observational study, we analyzed CTP scans and NIHSS scores from 89 patients in the acute phase. We employed a unique support vector regression approach to overcome limitations of traditional mass univariate analyses. Additionally, we used stability selection to identify the most consistent features across subsets, reducing overfitting and ensuring robust predictive models. We verified the consistency of results through nested cross-validation. Results: Both cortical and subcortical areas, including white matter tracts, showed associations with NIHSS scores. These regions aligned with functions such as language, spatial attention, sensory, and motor skills, all assessed by the NIHSS. Conclusions: Our findings reveal that hypoperfusion in specific brain regions, including previously underreported cortical areas, contributes to NIHSS scores in acute stroke. Moreover, this study introduces a novel brain mapping approach using CTP imaging and stability selection, offering a more comprehensive view of acute stroke impairments and the potential for recovery before structural reorganization occurs. |
| format | Article |
| id | doaj-art-1b74780e6828498083a3796ec06d8f95 |
| institution | OA Journals |
| issn | 2213-1582 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | NeuroImage: Clinical |
| spelling | doaj-art-1b74780e6828498083a3796ec06d8f952025-08-20T02:06:19ZengElsevierNeuroImage: Clinical2213-15822025-01-014510376110.1016/j.nicl.2025.103761Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute strokeHana Kim0Alex Teghipco1Chris Rorden2Julius Fridriksson3Mathew Chaves4Argye E. Hillis5Department of Communication Sciences & Disorders, University of South Florida, USADepartment of Psychology, University of South Carolina, USADepartment of Psychology, University of South Carolina, USADepartment of Communication Sciences & Disorders, University of South Carolina USADepartments of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, USADepartments of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, USA; Corresponding author at: Physical Medicine & Rehabilitation, and Cognitive Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.Background: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess stroke severity. While prior studies have identified subcortical regions where infarcts correlate with NIHSS scores, stroke symptoms can also arise from hypoperfusion, not just infarcts. Understanding the potential for neurological recovery post-reperfusion is essential for guiding treatment decisions. The goal of this study was to identify brain regions where hypoperfusion correlates with NIHSS scores, using computed tomography perfusion (CTP) scans in cases of acute ischemic stroke. Methods: In this prospective observational study, we analyzed CTP scans and NIHSS scores from 89 patients in the acute phase. We employed a unique support vector regression approach to overcome limitations of traditional mass univariate analyses. Additionally, we used stability selection to identify the most consistent features across subsets, reducing overfitting and ensuring robust predictive models. We verified the consistency of results through nested cross-validation. Results: Both cortical and subcortical areas, including white matter tracts, showed associations with NIHSS scores. These regions aligned with functions such as language, spatial attention, sensory, and motor skills, all assessed by the NIHSS. Conclusions: Our findings reveal that hypoperfusion in specific brain regions, including previously underreported cortical areas, contributes to NIHSS scores in acute stroke. Moreover, this study introduces a novel brain mapping approach using CTP imaging and stability selection, offering a more comprehensive view of acute stroke impairments and the potential for recovery before structural reorganization occurs.http://www.sciencedirect.com/science/article/pii/S2213158225000312CTPerfusionAcute Ischemic StrokeNIHSSBrain mapping |
| spellingShingle | Hana Kim Alex Teghipco Chris Rorden Julius Fridriksson Mathew Chaves Argye E. Hillis Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke NeuroImage: Clinical CT Perfusion Acute Ischemic Stroke NIHSS Brain mapping |
| title | Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke |
| title_full | Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke |
| title_fullStr | Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke |
| title_full_unstemmed | Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke |
| title_short | Hypoperfusion regions linked to National Institutes of Health Stroke Scale scores in acute stroke |
| title_sort | hypoperfusion regions linked to national institutes of health stroke scale scores in acute stroke |
| topic | CT Perfusion Acute Ischemic Stroke NIHSS Brain mapping |
| url | http://www.sciencedirect.com/science/article/pii/S2213158225000312 |
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