Published Ahead of Print on September 28, 2018 as 10.1212/WNL.

0000000000006437
ARTICLE

NIHSS cut-point for predicting outcome in

supra- vs infratentorial acute ischemic stroke
Sohei Yoshimura, MD, PhD, Richard I. Lindley, MD, Cheryl Carcel, MD, Shoichiro Sato, MD, PhD, Correspondence
Candice Delcourt, MD, PhD, Xia Wang, PhD, John Chalmers, MD, PhD, and Craig S. Anderson, MD, PhD, for the Dr. Anderson
ENCHANTED Investigators canderson@

®
georgeinstitute.org.cn
Neurology 2018;00:1-7. doi:10.1212/WNL.0000000000006437

Abstract
Objective
To determine the optimal cutpoint on the NIH Stroke Scale (NIHSS) for predicting poor
90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke
(AIS).

Methods
Data are from participants of the alteplase-dose arm of the randomized controlled trial,
Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
Associations between baseline characteristics of clinically defined supratentorial and infra-
tentorial AIS patients and poor functional outcome, defined by scores 3–6 on the modified
Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC)
receiver operating characteristics defining the optimal NIHSS predictor cutpoint.

Results
Patients with infratentorial AIS (n = 289) had lower baseline NIHSS scores than those with
supratentorial AIS (n = 2,613) (median 7 vs 9; p < 0.001). NIHSS cutpoints for poor outcome
were 10 (AUC 76, sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity
56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference
in functional outcome or symptomatic intracranial hemorrhage between AIS types.

Conclusions
In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for
infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because
thrombolysis treatment has low effect on stroke outcome in patients with infratentorial AIS
when baseline NIHSS score is more than 6, additional treatment such as endovascular treat-
ment should be considered to improve stroke outcome.

Clinicaltrials.gov identifier
NCT01422616.

From the Faculty of Medicine (S.Y., C.C., S.S., C.D., X.W., J.C., C.S.A.), The George Institute for Global Health, UNSW, Sydney, Australia; Department of Cerebrovascular Medicine (S.Y., S.
S.), National Cerebral and Cardiovascular Center, Osaka, Japan; Sydney Medical School (R.I.L.), Westmead Hospital, University of Sydney; Neurology Department (C.C., C.D., C.S.A.),
Royal Prince Alfred Hospital, Sydney Health Partners, Australia; and The George Institute China at Peking University Health Science Center (C.S.A.), Beijing, China.

Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

ENCHANTED coinvestigators are listed at links.lww.com/WNL/A725.

Copyright © 2018 American Academy of Neurology 1

Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
 Glossary
AIS = acute ischemic stroke; CI = confidence interval; ENCHANTED = Enhanced Control of Hypertension and
Thrombolysi2s Stroke Study; mRS = modified Rankin Scale; NIHSS = NIH Stroke Scale; ROC = receiver operating
characteristic.
The NIH Stroke Scale (NIHSS) is the most widely used
measure of neurologic severity to determine eligibility for
reperfusion therapy for acute ischemic stroke (AIS) in
clinical practice and research.1–3 However, posterior circu-
lation AIS has worse functional outcome relative to supra-
tentorial AIS for a given NIHSS score,4,5 largely because
brainstem or cerebellum deficits are poorly represented on
this scale.4 This discrepancy may lead patients with infra-
tentorial AIS being denied thrombolysis treatment based on
a single low NIHSS score (e.g., <6), to define those with
potentially less favorable benefit:risk ratio for the treatment.
We aimed to determine the optimal cutpoint on the NIHSS
for predicting poor functional outcome in supratentorial and
infratentorial AIS through analyses of a broad range of
thrombolysis-treated patients who participated in the
Enhanced Control of Hypertension and Thrombolysis
Stroke Study (ENCHANTED).
Methods
Design and assessments
ENCHANTED is an ongoing international, multicenter,
randomized, open, blinded endpoint trial with a quasifactorial
design. The first arm of the study comparing the effectiveness
of low dose (0.6 mg/kg) vs standard dose (0.9 mg/kg) IV
alteplase is complete6,7; the other arm comparing intensive vs
guideline-recommended blood pressure management is on-
going. The current study relates to the dataset from the
alteplase dose arm.
ENCHANTED was approved by all relevant regulatory au-
thorities and ethics committees of participating centers, and
written informed consent was obtained from patients or their
approved surrogate. The study is registered with Clin-
icalTrials.gov (NCT01422616).
Key demographic and clinical characteristics, including
NIHSS, were recorded at the time of enrollment. Participants
also had an assessment with the NIHSS at 24 hours post-
randomization and day 3 (or immediately before discharge if
earlier). Noncontrast brain CT imaging or MRI were con-
ducted prior to randomization, at 24 ± 3 hours, and addi-
tionally if indicated. The location of the stroke lesion was
reported by each investigator on electronic case report forms:
those with reference to the cerebral hemisphere and cere-
bellum or brainstem were classified as supratentorial and
infratentorial AIS, respectively. All brain images collected in
DICOM format were de-identified and uploaded via a web-
based system for central assessment where at least 2 assessors
2 Neurology | Volume , Number  | Month 0, 2018
Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
recorded any intracranial hemorrhage blind to clinical, se-
quence, time, and image-adjunct data, using MIStar version
3.2 (Apollo Medical Imaging Technology, Melbourne, Aus-
tralia). The primary outcome was poor functional outcome
defined by scores of 3–6 on the modified Rankin Scale (mRS)
assessed at 90-day postrandomization. The primary safety
outcome was symptomatic ICH according to all standard
definitions. The recording of any intracranial hemorrhage was
based on standard definitions.6,7 Other outcomes included
death within 90 days, death or neurologic deterioration within
24 hours and 7 days, any ICH, and health-related quality of life
assessed using the EQ-5D8 questionnaire. Neurologic de-
terioration was defined as an increase of 4 or more from
baseline in the NIHSS score.
Statistical analysis
Baseline data were summarized as median (interquartile
range), number (%), and mean (SD) for skewed, categorical,
and normally distributed variables, respectively. Variables were
compared using Student t test, Mann-Whitney U test, Pearson
χ 2 test, or Fisher exact test, as appropriate. Logistic regression
models were used to determine independent predictors of poor
outcome (mRS scores 3–6), after adjustment for sex, age, and
significance (p < 0.05) identified in univariate analysis for
supratentorial and infratentorial groups, and reported as odds
ratios with 95% confidence intervals (CI). The optimal pre-
dictor cutpoints on the NIHSS were determined from con-
structed receiver operating characteristic (ROC) curves with
the Youden9 method. Statistical analyses were conducted using
SAS version 9.3 (SAS Institute, Cary, NC).
Data availability
Individual de-identified participant data used in this analysis
will be shared by request from any qualified investigator via
the Research Office of The George Institute.
Results
Among 3,310 AIS participants in the ENCHANTED alteplase
dose arm, 2,902 were included in these analyses: 2,613 with
supratentorial and 289 with infratentorial AIS. Those ex-
cluded had missing information on lesion location (n = 267),
both supratentorial and infratentorial lesions (n = 128), no
consent (n = 9), duplicate randomization (n = 3), or mistaken
randomization (n = 1).
Table 1 shows the clinical characteristics of included AIS
patients, where those with infratentorial lesions were more
often Asian and had diabetes mellitus but were less likely to
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Table 1 Baseline characteristics and stroke features by stroke lesion
Supratentorial (n = 2,613) Infratentorial (n = 289) p Value

Baseline characteristics

Age, y 68 (59–76) 66 (59–74) 0.062

Female 980 (38) 93 (32) 0.086

Asian race 1,672 (64) 205 (71) 0.023

Medical history

Hypertension 1,648 (63) 192 (66) 0.288

Any stroke 440 (17) 60 (21) 0.111

Coronary artery disease 373 (14) 46 (16) 0.506

Atrial fibrillation 552 (21) 27 (9) <0.001

Diabetes mellitus 497 (19) 72 (25) 0.021

Hypercholesterolemia 443 (17) 43 (15) 0.416

Current cigarette use 617 (24) 71 (25) 0.778

mRS 0 before stroke 2,133 (82) 242 (84) 0.438

Use of antihypertensive agent 1,196 (46) 136 (47) 0.723

Use of statin or lipid-lowering agent 476 (18) 54 (19) 0.915

Use of antiplatelet agent 602 (23) 63 (22) 0.683

Use of anticoagulant 70 (3) 3 (1) 0.111

Stroke features

Neurologic symptoms

Unilateral paresis ± sensory deficit of face 2087 (80) 207 (72) <0.001

Unilateral paresis ± sensory deficit of arm/hand 2,274 (87) 218 (75) <0.001

Unilateral weakness ± sensory deficit of leg/foot 2,176 (83) 217 (75) <0.001

Dysphasia 1,631 (62) 163 (56) 0.093

Homonymous hemianopia 481 (18) 27 (9) <0.001

Visuospatial disorder 510 (20) 28 (10) <0.001

Brainstem or cerebellar signs 177 (7) 123 (43) <0.001

Other neurologic deficit 344 (13) 66 (23) <0.001

NIHSS score on admission 9 (5–14) 7 (4–11) <0.001

Signs of cerebral ischemia on initial brain imaging 642 (25) 60 (21) 0.173

Visible infarct lesion on initial brain imaging 599/2,613 (23) 69/289 (23.9) 0.771

Proximal vessel occlusion on CTA or MRA 433/2,578 (17) 33/288 (11.5) 0.025

Final diagnosis at time of hospital discharge

Large-artery occlusion from significant atheroma 1,086/2,613 (42) 106/289 (37) 0.124

Lacunar disease 537/2,613 (21) 99/289 (34) <0.001

Cardioembolism 576/2,613 (22) 28/289 (10) <0.001

Dissection 19/2,613 (1) 4/289 (1) 0.279

Other or uncertain cause of stroke 395/2,613 (15) 52/289 (18) 0.230

Abbreviations: CTA = CT angiography; MRA = magnetic resonance angiography; mRS = modified Rankin Scale; NIHSS = NIH Stroke Scale.
Data are presented as median (interquartile range), number (%), or mean ± SD.

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Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
 have atrial fibrillation compared to those with supratentorial
lesions. Moreover, compared to supratentorial AIS, patients
with infratentorial AIS had lower baseline NIHSS scores
(median 7 vs 9; p < 0.001), more frequent lacunar syndrome,
and less proximal vessel occlusion and cardioembolic etiology.
Table 2 presents the treatment, clinical course, and outcomes
for the 2 groups. Although infratentorial AIS was associated
with longer onset to treatment (alteplase) time and less
rehabilitation compared to supratentorial AIS, there was no
difference in functional outcome and symptomatic ICH by
any definition despite any ICH being lower after infratentorial
AIS (8.3% vs 19.1%; p < 0.001). There was no significant
association between stroke location and poor functional
outcome after multivariable analysis in patients with mild
(NIHSS 0–5), moderate (NIHSS 6–10), and severe (NIHSS
≥11) stroke severity (table e-1, doi.org/10.5061/dryad.
1kn74rt). There was no difference in death within 90 days,

Table 2 Treatment, clinical course, and outcome by lesion location

Supratentorial (n = 2,613) Infratentorial (n = 289) p Value

Treatment

Time from stroke onset to alteplase 170 (125–215) 180 (133–225) 0.047

Estimated body weight prior to alteplase 69.5 ± 14.4 69.9 ± 12.8 0.611

Any alteplase given to patients 2,596 (99) 287 (99) 0.714

Low-dose alteplase 1,315 (50) 146 (51) 1.000

Endovascular therapy 107 (4) 6 (2) 0.128

Nasogastric feeding 487 (19) 55 (19) 0.917

Rehabilitation therapy 1,364 (52) 132 (46) 0.046

Hospitalization, d 10 (5–18) 11 (6–17) 0.260

Outcomes

Death or major disability at 90 days 975/2,564 (38) 94/283 (33) 0.128

mRS score at 3 months 2 (1–4) 2 (0–3) 0.252

Death within 90 days 213 (8) 29 (10) 0.324

Death or neurologic deterioration within 24 hours 197 (8) 24 (8) 0.727

Death or neurologic deterioration within 7 days 292 (11) 37 (13) 0.465

a
Symptomatic ICH (SITS-MOST) 38 (2) 1 (0.4) 0.174

Symptomatic ICH (NINDS)b 187 (7) 12 (4) 0.073

c
Symptomatic ICH (ECASS2) 110 (4) 9 (3) 0.462

d
Symptomatic ICH (ECASS3) 44 (2) 4 (1) 1.000

Symptomatic ICH (IST3)e 62 (2) 5 (2) 0.679

Fatal ICHf within 7 days 21 (1) 1 (0) 0.718

Any ICH 498 (19) 24 (8) <0.001

EQ-5D at 3 months 0.64 ± 0.41 0.66 ± 0.40 0.545

Abbreviations: ECASS = European–Australian Cooperative Acute Stroke Study; EQ-5D = EuroQoL Group 5-Dimension Self-Report Questionnaire; ICH =
intracerebral hemorrhage; IST3 = third International Stroke Trial; mRS = modified Rankin Scale; NIHSS = NIH Stroke Scale; NINDS = National Institute of
Neurologic Diseases and Stroke; SITS-MOST= Safe Implementation of Thrombolysis in Stroke–Monitoring Study.
Data are presented as median (interquartile range), number (%), or mean ± SD.
a
The definition of symptomatic ICH from SITS-MOST: a large local or remote parenchymal ICH (type 2, defined as greater than 30% of the infarcted area
affected by hemorrhage with mass effect or extension outside the infarct) combined with neurologic deterioration (≥4 points on the NIHSS score) or leading to
death within 36 hours.
b
The definition of symptomatic ICH from the NINDS trial: any ICH associated with neurologic deterioration (≥1 point change in NIHSS score) from baseline or
death within 36 hours.
c
The definition of symptomatic ICH from the ECASS2: any ICH with neurologic deterioration (≥4 points on the NIHSS score) from baseline or death within 36
hours.
d
The definition of symptomatic ICH from the ECASS3: any ICH with neurologic deterioration (≥4 points increase on the NIHSS score) from baseline or death
within 36 hours.
e
The definition of symptomatic ICH from the IST3: any significant ICH (local or distant from the infarct) or significant hemorrhagic transformation of an infarct
on brain imaging with clinically significant deterioration or death within the first 7 days of treatment.
f
Any parenchymal ICH of type 2 and death.

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Table 3 Baseline predictors of modified Rankin Scale (mRS) score 3–6 at 90 days by stroke lesion location
Supratentorial Infratentorial

Unadjusted analysis Multivariable analysis Unadjusted analysis Multivariable analysis

mRS 0–2 mRS 0–2 mRS 3–6

(n = 1,589) mRS 3–6 (n = 975) p Value OR 95% CI p Value (n = 189) (n = 94) p Value OR 95% CI p Value

Age, y 66 (57–74) 72 (63–79) <0.001 1.03 1.02–1.04 <0.001 65 (57–73) 69 (61–77) 0.010 1.03 1.01–1.06 0.014

Female 34 43 <0.001 1.11 0.90–1.38 0.331 30 36 0.376 1.20 0.68–2.14 0.531

Asian race 68 60 <0.001 0.92 0.72–1.18 0.528 74 66 0.199

Hypertension 61 67 0.002 1.02 0.83–1.25 0.866 63 73 0.106

Any stroke 16 19 0.028 0.92 0.71–1.20 0.543 22 20 0.895

Coronary artery disease 12 18 <0.001 1.02 0.78–1.34 0.883 14 21 0.149

Atrial fibrillation 16 30 <0.001 1.20 0.91–1.59 0.199 5 20 <0.001 3.75 1.22–11.6 0.022

Diabetes mellitus 17 22 0.002 1.51 1.19–1.92 <0.001 21 31 0.101

Hypercholesterolemia 15 19 0.007 0.97 0.71–1.31 0.827 13 19 0.208

Current cigarette use 25 21 0.020 1.26 1.00–1.60 0.051 25 20 0.414

mRS 0 before stroke 87 73 <0.001 0.49 0.38–0.63 <0.001 85 80 0.327

Antihypertensive agent 43 51 <0.001 1.30 0.91–1.85 0.149 46 49 0.675

Lipid-lowering agent 16 21 0.006 1.01 0.74–1.39 0.951 18 20 0.772

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Antiplatelet agent 20 27 <0.001 1.08 0.84–1.40 0.548 22 22 1

Anticoagulant 2 4 0.031 1.74 0.97–31.0 0.062 0 3 0.036 >999 0–999 0.986

NIHSS score 7 (4–11) 13 (9–18) <0.001 1.18 1.16–1.20 <0.001 6 (4–10) 9 (6–15) <0.001 1.08 1.03–1.12 <0.001

Cerebral ischemia 21 29 <0.001 1.15 0.92–1.44 0.220 18 26 0.186

Cardioembolism 18.5 27.6 <0.001 0.77 0.58–1.02 0.070 6.4 17.0 0.009 0.84 0.27–2.59 0.763

Time to alteplase, min 176 (130–220) 165 (122–210) 0.005 1.00 0.92–1.08 0.935 187 (135–225) 170 (115–219) 0.108

Estimated body weight 70 ± 14 69 ± 15 0.028 1.00 0.99–1.01 0.646 70 ± 12 69 ± 15 0.454

Abbreviations: CI = confidence interval; NIHSS = NIH Stroke Scare; OR = odds ratio.

Data are presented as median (interquartile range), %, or mean ± SD.
5
 Figure 1 Receiver operating characteristic (ROC) curve to determine the NIH Stroke Scale cutpoint for predicting poor
functional outcome
A, B) Arrows show the optimal cutpoint by the Youden method. CI = confidence interval.
death or neurologic deterioration within 24 hours and 7 days,
or health-related quality of life. Table 3 shows the factors
associated with poor functional outcome according to
supratentorial and infratentorial AIS, in particular highlighting
the significance of baseline neurologic severity according to
NIHSS on admission in multivariable analysis.
Figure 1 shows ROC curves for NIHSS scores in relation to
poor functional outcome, the areas under the curve being 0.76
(95% CI 0.74–0.78) and 0.69 (95% CI 0.63–0.75) in supra-
tentorial and infratentorial AIS, respectively. Optimal NIHSS
cutpoints were 10 (sensitivity 65%, specificity 73%) in
supratentorial AIS and 6 (sensitivity 72%, specificity 56%) in
infratentorial AIS. ROC curve analysis stratified by age (<60
vs ≥60 years) and baseline Glasgow Coma Scale score (3–12
vs 13–15) to decrease the potential confounding of this po-
tent predictive factor show similar results (figures e-1 and e-2,
doi.org/10.5061/dryad.1kn74rt).
Discussion
In this analysis using a clinical trial dataset of guideline-
recommended thrombolysis-treated AIS patients, those with
infratentorial lesions had less neurologic severity and conse-
quently lower prognostic cutpoint for poor clinical outcome
on the common NIHSS scale compared to those with supra-
tentorial lesions. However, there was no significant difference in
functional outcome or symptomatic ICH between the 2 groups.
There have been 2 prior single-center studies that assessed
cutpoints on the NIHSS for predicting functional outcome
in patients with posterior circulation compared to anterior
6 Neurology | Volume , Number  | Month 0, 2018
Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
circulation AIS. The first study showed that the optimal base-
line NIHSS cutpoints for predicting recovery (mRS 0–2) were
5 and 8 for posterior circulation and anterior circulation AIS,
respectively, in 310 patients without thrombolysis treatment
recruited within 3 days after the onset of symptoms.4 The other
study also showed the NIHSS cutpoints of 4 and 8 for posterior
circulation and anterior circulation AIS, respectively, predicted
recovery (modified Barthel Index score ≥18) in a registry of
1,569 AIS patients, of whom 24% received IV alteplase.5 While
these reports are consistent in showing that patients with
posterior circulation AIS have worse functional outcome on the
NIHSS relate to those with anterior circulation AIS, there has
been limited information specifically in those eligible for
thrombolysis, where there may be differences in prognosis.10
Thus, our study adds further information related to the limi-
tation of the NIHSS with respect to grading the severity of
posterior circulation AIS, with a 4-point difference in relative
prognosis on the scale between supratentorial and infratento-
rial AIS, as also emphasized in other reports.4,5
In the event of hemorrhagic transformation of infratentorial
AIS after thrombolysis, the outcome often leads to rapid de-
terioration and death because of mass effect within the narrow
posterior fossa. Another report has shown lower frequency of
symptomatic ICH after IV alteplase in infratentorial AIS,10
whereas our analyses found no difference in this adverse
outcome between the groups. The significantly lower fre-
quency of “any ICH” in infratentorial AIS likely reflects the
relatively lower size of the ischemic lesion in this location.
A meta-analysis of trials of IV alteplase in AIS suggests the
broad benefits of this treatment extend to patients with mild
neurologic severity (NIHSS 0–4),11 but evidence for the
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balance of benefits and risks specifically in patients with
infratentorial AIS is unclear.12–17 Given that infratentorial AIS
has a 4-point lower NIHSS score relative to supratentorial AIS
for similar prognosis for functional outcome, and with similar
risks of symptomatic ICH, it is even more important that
thrombolysis should not be withheld in infratentorial AIS on
the misunderstanding that low NIHSS equates to good
prognosis. Moreover, additional treatment such as endovas-
cular treatment should be considered since thrombolysis
treatment has low effect on stroke outcome in patients with
infratentorial AIS with 6 or more NIHSS score.
The strengths of our analysis include the systematic and pro-
spective measurement of outcomes in a large cohort of
thrombolysis-treated AIS patients across a wide range of health
services. However, a limitation is selection bias from this being
a clinical trial population where study investigators are likely to
have excluded patients with less typical stroke symptoms that
can be difficult to distinguish from peripheral vertigo, migraine,
seizure, and syncope, which more often pertain to infratentorial
rather than supratentorial AIS. Another issue is that cases of
AIS might have been missed on the basis of a diagnosis reliant
on CT rather than MRI, which was used in only a minority of
cases. However, the large majority of our cases had their stroke
location confirmed on follow-up brain imaging, and in the
context of the best practice, real-world AIS management. Of
course, we are unable to determine the effectiveness of
thrombolysis in cases of infratentorial stroke with mild scores
on the NIHSS without a control group.
Our large-scale investigation of thrombolysis-treated AIS
patients confirms that infratentorial lesions have less severe
measureable neurologic deficit for similar level of functional
outcome as compared to supratentorial lesions. Moreover,
there was no appreciable difference in the harm or functional
outcome following alteplase between the 2 AIS groups. Be-
cause thrombolysis treatment has low effect on stroke outcome
in patients with infratentorial AIS when baseline NIHSS score
is more than 6, additional treatment such as endovascular
treatment should be considered to improve stroke outcome.
Author contributions
S. Yoshimura analyzed and interpreted the data and wrote the
first manuscript draft. C. Carcel, S. Sato, and C. Delcourt
contributed to study concept and design. X. Wang interpreted
the data. R.I. Lindley and J. Chalmers supervised the study. C.
S.A. initiated and developed the study concept, interpreted
the data, supervised the study, and provided input on the
manuscript. All authors made critical revisions of the
manuscript.
Study funding
This study was funded by grants from the National Health and
Medical Research Council of Australia, the Stroke Association
of the United Kingdom, the Ministry of Health and the Na-
tional Council for Scientific and Technological Development
of Brazil (467322/2014–7 and 402388/2013–5), and the
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Ministry for Health, Welfare, and Family Affairs of the Re-
public of Korea (HI14C1985).
Disclosure
S. Yoshimura reports no disclosures relevant to the manu-
script. R.I. Lindley reports receiving speaking fees from
Covidien and Pfizer. C. Carcel reports no disclosures relevant
to the manuscript. S. Sato reports employment by Bayer
HealthCare Pharmaceuticals’ Japanese subsidiary, Bayer
Yakuhin, from January 2018, but all his contribution to this
study was made during his employment in the National Ce-
rebral and Cardiovascular Center. C. Delcourt and X. Wang
report no disclosures relevant to the manuscript. J. Chalmers
reports receiving grants from the NHMRC and Servier for the
ADVANCE (Action in Diabetes and Vascular Disease: Pre-
terax and Diamicron MR Controlled Evaluation) trial and the
ADVANCE-ON post-trial follow-up study, and honoraria to
speak about those trials at scientific meetings. C. Anderson
reports receiving speaker fees from Takeda and advisory panel
fees from Amgen. Go to Neurology.org/N for full disclosures.
Publication history
Received by Neurology May 1, 2018. Accepted in final form July
23, 2018.
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Neurology | Volume , Number  | Month 0, 2018 7
 NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic
stroke
Sohei Yoshimura, Richard I. Lindley, Cheryl Carcel, et al.
Neurology published online September 28, 2018
DOI 10.1212/WNL.0000000000006437

This information is current as of September 28, 2018

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