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*Only for medical professionals to read and refer to the exciting content of the ISC conference! The National Institutes of Health Stroke Scale (NIHSS) score is widely used to evaluate stroke neurological deficits, and plays an important role in emergency thrombolysis for ischemic stroke, inpatient evaluation of stroke patients, and stroke-related scientific research.
important role
.
There are two eye-related scores in the NIHSS score, the gaze score and the visual field defect score
.
At the 2022 International Stroke Conference (ISC 2022), Professor Alicia Richardson brought you a detailed tutorial on NIHSS score gaze and visual field defect assessment according to anatomical parts.
Let's learn together
.
Posterior cerebral artery disease Stroke that occurs with posterior cerebral artery disease is a posterior circulation stroke
.
Posterior cerebral artery lesions can lead to visual field defects, the anatomical basis of which is the visual pathway
.
First, let's review the complete visual pathway together: retinal optic ganglion cells - optic nerve - optic chiasm - optic tract - lateral geniculate body - optic radiation - occipital visual center occipital visual center (Figure 1) It mainly includes areas 17-19 of Broadman's subarea.
Area 17 of Broadman's subarea is the primary visual cortex; areas 18 and 19 of Broadman's subarea are visual joint areas
.
Figure 1 The comparison of visual pathway lesions and visual field defects in the occipital lobe visual center (adapted from the speaker's PPT) is shown in Figure 2
.
If the lesion is located before the chiasm, a monocular visual field defect occurs; if the lesion is located behind the optic chiasm, a binocular visual field defect occurs, and it is isotropic
.
Figure 2 Visual pathway lesions and visual field defects (speaker PPT) posterior cerebral artery lesions, possibly related to the NIHSS scoring of visual fields (Figure 3)
.
Visual field scores range from 0 to 3 points
.
A score of 0 means no visual field defect
.
A score of 1 indicates partial visual field defect, including quadrant blindness
.
A score of 2 represents complete hemianopia
.
3 points are only used for total blindness, including cortical blindness
.
It is important to note that a visual field score of 3 is very rare
.
Bilateral cortical blindness is seen in basilar apical infarction or bilateral posterior cerebral artery infarction (Figure 4)
.
If the visual field score gives 3 points, we need to pay special attention and should carefully check whether the lesions match
.
Figure 3 NIHSS score of visual field score Figure 4 Bilateral cortical blindness seen in basilar artery tip or bilateral posterior cerebral artery infarction (speaker PPT) middle cerebral artery lesions Middle cerebral artery lesions involve both gaze and visual fields in the NIHSS score
.
The anatomical basis of gaze changes in middle cerebral artery lesions is that middle cerebral artery lesions can involve the frontal eye movement area of the brain, that is, area 8 of the Brodman zone (Fig.
5)
.
Following the infarction at this site, the eyes will stare toward the side of the lesion
.
For example, an infarction of the right middle cerebral artery results in an infarction of the right frontal eye movement area, and the patient's eyes gaze to the right
.
Figure 5.
The gaze score in the frontal eye movement area (speaker PPT) NIHSS score is the score given by the patient's horizontal eye movement examination (Figure 6)
.
Gaze scores range from 0-2 points
.
A score of 0 indicates normal eye movement
.
A score of 1 indicates partial gaze palsy, abnormal gaze in one or both eyes, but no passive gaze or complete gaze palsy
.
A score of 2 indicates passive gaze or complete gaze paralysis, which cannot be overcome by eye-head movements
.
Figure 6 NIHSS Gaze Score Middle cerebral artery lesions, which can also lead to visual field defects
.
As shown in Figure 7, depending on the location of the middle cerebral artery infarction, there are 4, 5, and 6 types of visual field defects
.
The NIHSS score of type 4 has a visual field score of 2 points, and the score of type 5 and type 6 is 1 point (refer to Figure 3)
.
Figure 7 Visual field defect due to middle cerebral artery disease (adapted from speaker's PPT) Brainstem Lesion Stroke at the brainstem site can lead to cranial neuropathy
.
Medulla oblongata, pons, and midbrain strokes can lead to neuropathies of cranial nerves 9-12, 5-8, and 3-4, respectively (Figure 8)
.
The cranial nerves involved in eye movement are the 3rd, 4th, and 6th cranial nerves, which involve the pons and midbrain
.
NIHSS scores may involve gaze scores in brainstem lesions (Fig.
6)
.
Figure 8 Brainstem lesions and corresponding cranial nerves Figure 9 shows the abnormal eye movement caused by the 3rd, 4th, and 6th cranial neuropathy.
It is recommended that you save a screenshot
.
The 4th and 6th cranial neuropathy is uncommon in stroke, and here we focus on the 3rd cranial nerve (oculomotor nerve) lesions, which are manifested as: (1) the eyeball is oriented obliquely downward; (2) pupillary examination, ischemic lesions usually The pupillary response is normal; if the pupil is dilated or unresponsive, it may be secondary to a space-occupying lesion; (3) the eye accommodation reflex is abnormal; (4) ptosis
.
Figure 9 Abnormal eye movement due to cranial neuropathy 3, 4, and 6 (speaker PPT) Brainstem lesions may also cause diplopia
.
It should be noted that the symptom of diplopia is not caused by lesions of the occipital lobe, but caused by damage to the parts of the brainstem that control eye movement
.
Common in extraocular myopathy or neuropathy governing eye movement
.
Mastering the NIHSS score is the hard skill of every neurologist.
After the introduction of this speaker, we can find that the simple visual field score and gaze score are full of knowledge content of positioning and diagnosis
.
Next time I will review the NIHSS score, try to think about and apply the positioning knowledge related to visual field and eye movement
.
Source of this article: Neurology Channel of the Medical Community , and the accuracy and completeness of the cited information (if any), and does not assume any responsibility for the outdated content, possible inaccuracy or incompleteness of the cited information
.
Relevant parties are requested to check separately when adopting or using it as a basis for decision-making
.
Contribution/reprint/business cooperation: yxjsjbx@yxj.
org.
cn
important role
.
There are two eye-related scores in the NIHSS score, the gaze score and the visual field defect score
.
At the 2022 International Stroke Conference (ISC 2022), Professor Alicia Richardson brought you a detailed tutorial on NIHSS score gaze and visual field defect assessment according to anatomical parts.
Let's learn together
.
Posterior cerebral artery disease Stroke that occurs with posterior cerebral artery disease is a posterior circulation stroke
.
Posterior cerebral artery lesions can lead to visual field defects, the anatomical basis of which is the visual pathway
.
First, let's review the complete visual pathway together: retinal optic ganglion cells - optic nerve - optic chiasm - optic tract - lateral geniculate body - optic radiation - occipital visual center occipital visual center (Figure 1) It mainly includes areas 17-19 of Broadman's subarea.
Area 17 of Broadman's subarea is the primary visual cortex; areas 18 and 19 of Broadman's subarea are visual joint areas
.
Figure 1 The comparison of visual pathway lesions and visual field defects in the occipital lobe visual center (adapted from the speaker's PPT) is shown in Figure 2
.
If the lesion is located before the chiasm, a monocular visual field defect occurs; if the lesion is located behind the optic chiasm, a binocular visual field defect occurs, and it is isotropic
.
Figure 2 Visual pathway lesions and visual field defects (speaker PPT) posterior cerebral artery lesions, possibly related to the NIHSS scoring of visual fields (Figure 3)
.
Visual field scores range from 0 to 3 points
.
A score of 0 means no visual field defect
.
A score of 1 indicates partial visual field defect, including quadrant blindness
.
A score of 2 represents complete hemianopia
.
3 points are only used for total blindness, including cortical blindness
.
It is important to note that a visual field score of 3 is very rare
.
Bilateral cortical blindness is seen in basilar apical infarction or bilateral posterior cerebral artery infarction (Figure 4)
.
If the visual field score gives 3 points, we need to pay special attention and should carefully check whether the lesions match
.
Figure 3 NIHSS score of visual field score Figure 4 Bilateral cortical blindness seen in basilar artery tip or bilateral posterior cerebral artery infarction (speaker PPT) middle cerebral artery lesions Middle cerebral artery lesions involve both gaze and visual fields in the NIHSS score
.
The anatomical basis of gaze changes in middle cerebral artery lesions is that middle cerebral artery lesions can involve the frontal eye movement area of the brain, that is, area 8 of the Brodman zone (Fig.
5)
.
Following the infarction at this site, the eyes will stare toward the side of the lesion
.
For example, an infarction of the right middle cerebral artery results in an infarction of the right frontal eye movement area, and the patient's eyes gaze to the right
.
Figure 5.
The gaze score in the frontal eye movement area (speaker PPT) NIHSS score is the score given by the patient's horizontal eye movement examination (Figure 6)
.
Gaze scores range from 0-2 points
.
A score of 0 indicates normal eye movement
.
A score of 1 indicates partial gaze palsy, abnormal gaze in one or both eyes, but no passive gaze or complete gaze palsy
.
A score of 2 indicates passive gaze or complete gaze paralysis, which cannot be overcome by eye-head movements
.
Figure 6 NIHSS Gaze Score Middle cerebral artery lesions, which can also lead to visual field defects
.
As shown in Figure 7, depending on the location of the middle cerebral artery infarction, there are 4, 5, and 6 types of visual field defects
.
The NIHSS score of type 4 has a visual field score of 2 points, and the score of type 5 and type 6 is 1 point (refer to Figure 3)
.
Figure 7 Visual field defect due to middle cerebral artery disease (adapted from speaker's PPT) Brainstem Lesion Stroke at the brainstem site can lead to cranial neuropathy
.
Medulla oblongata, pons, and midbrain strokes can lead to neuropathies of cranial nerves 9-12, 5-8, and 3-4, respectively (Figure 8)
.
The cranial nerves involved in eye movement are the 3rd, 4th, and 6th cranial nerves, which involve the pons and midbrain
.
NIHSS scores may involve gaze scores in brainstem lesions (Fig.
6)
.
Figure 8 Brainstem lesions and corresponding cranial nerves Figure 9 shows the abnormal eye movement caused by the 3rd, 4th, and 6th cranial neuropathy.
It is recommended that you save a screenshot
.
The 4th and 6th cranial neuropathy is uncommon in stroke, and here we focus on the 3rd cranial nerve (oculomotor nerve) lesions, which are manifested as: (1) the eyeball is oriented obliquely downward; (2) pupillary examination, ischemic lesions usually The pupillary response is normal; if the pupil is dilated or unresponsive, it may be secondary to a space-occupying lesion; (3) the eye accommodation reflex is abnormal; (4) ptosis
.
Figure 9 Abnormal eye movement due to cranial neuropathy 3, 4, and 6 (speaker PPT) Brainstem lesions may also cause diplopia
.
It should be noted that the symptom of diplopia is not caused by lesions of the occipital lobe, but caused by damage to the parts of the brainstem that control eye movement
.
Common in extraocular myopathy or neuropathy governing eye movement
.
Mastering the NIHSS score is the hard skill of every neurologist.
After the introduction of this speaker, we can find that the simple visual field score and gaze score are full of knowledge content of positioning and diagnosis
.
Next time I will review the NIHSS score, try to think about and apply the positioning knowledge related to visual field and eye movement
.
Source of this article: Neurology Channel of the Medical Community , and the accuracy and completeness of the cited information (if any), and does not assume any responsibility for the outdated content, possible inaccuracy or incompleteness of the cited information
.
Relevant parties are requested to check separately when adopting or using it as a basis for decision-making
.
Contribution/reprint/business cooperation: yxjsjbx@yxj.
org.
cn
