How to recognize and evaluate the early stage of acute posterior circulation ischemic stroke, these 4 scales should be known|Guideline consensus

The incidence of acute posterior circulation ischemic stroke (aPCI) is high, accounting for about 20% to 25% of all ischemic strokes, with an annual incidence rate of 18 per 100,000.
It is an important cause of disability and death in stroke patients, but its Compared with acute anterior circulation ischemic stroke, it has not attracted enough attention and effective management.
For this reason, on the basis of combining the clinical characteristics of aPCI, the conditions of stroke prevention and treatment in various places, and the relevant international research progress and guidelines, Hubei Province Cerebrovascular Disease The Society of Prevention and Treatment organized experts in the province to formulate this consensus, which aims to help improve the early recognition of aPCI by primary-level stroke prevention and treatment stations, first-aid workers and clinicians at all levels of stroke centers, to better guide clinical treatment and improve patient prognosis.
This article will agree.
A brief summary of the recommendations for early identification and evaluation of acute posterior circulation ischemic stroke.

Recommendations for early recognition and evaluation of acute posterior circulation ischemic stroke 1.
Medical history consultation and physical examination ➤ Head pulse, nystagmus, eye deviation test (HINTS) three-step inspection method HINTS three-step inspection method (Table 1) is proven It is an effective method for screening PCI patients with AVS.
The sensitivity and specificity of HINTS to stroke can reach 98% and 85%, respectively.
It can identify and differentiate PCI quickly and accurately, and is more sensitive than PCI Early MRI (sensitivity of 88% within 48 hours of onset) is higher.Recommendation: When the clinical symptoms of PCI patients are not typical, it is difficult to identify early.
When asking the medical history, you should be as detailed as possible to find clues related to PCI.
Use some physical examination tests based on the targeted medical history.
For example, ataxia test, gait test, visual field test, balance test, etc.
can improve the detection rate of PCI.
HINTS and HINTS PLUS are not only simple and fast, but also highly sensitive to the identification of PCI patients with AVS.
It is even better than MRI DWI in the early diagnosis of PCI.
It is of great significance in reducing diagnosis costs, improving diagnosis accuracy, saving pre-hospital treatment time, and avoiding ineffective treatment and waste of resources caused by misdiagnosis.
But this Examination is also limited because of the low positive rate and high requirements for the operator.
2.
Symptomological evaluation scale for acute post-circulatory ischemic stroke ➤ TIA or TIA of the circulatory system after the acute post-acute circulatory TIA early identification scale The risk of early stroke recurrence events in small strokes is higher than that of the anterior circulatory system.
Early identification of post-circulation TIA can significantly reduce the risk of recurrence events.
The ABCD score series can predict the risk of TIA progressing to early stroke (Table 2).
3.
Posterior Circulation Infarction Assessment Scale ➤ Traditional NIHSS and extended NIHSS (e-NIHSS) NIHSS is one of the most commonly used clinical scales to assess the degree of neurological dysfunction in stroke patients.
It can target different aspects of neurological function and neurological symptoms Quantitative evaluation of physical and physical signs.
However, the NIHSS scoring item does not cover all neurological dysfunctions of acute stroke, especially the posterior circulatory system, such as headache, nausea, Horner’s sign, diplopia, dysphagia, abnormal gait, and hearing impairment And nystagmus, the information provided for evaluating aPCI is very limited.
Even patients with a NIHSS score of 0 may still have posterior circulation infarction.
Foreign studies have used the e-NIHSS score scale (Table 3) to evaluate the severity of PCI Degree.
Emergency Room Stroke Recognition (ROSIER) Scale ROSIER Scale (Table 4) is a set of rapid identification tools for prehospital, in-hospital emergency and hospital triage designed by Nor AM research group in 2005.
It is recommended It is used to screen all patients with suspected stroke.
Recommendation: The use of the stroke scale has greatly improved the recognition rate of acute ischemic stroke, but so far there is no single scale that can describe and predict all aspects of stroke.
There are only a handful of scales for evaluating PCI.
In the selection of scales, reliability and validity should be considered.
The scope of use and advantages and disadvantages of each stroke scale should be considered in combination with the patient population.
A reasonable choice based on detailed and accurate medical history and imaging data.
For patients suspected of PCI-TIA, consider using the ABCD score series.
If conditions permit, it is recommended to use the ABCD3-I score that incorporates the imaging examination results into the assessment ; For patients with suspected posterior circulation infarction, it is recommended to use the e-NIHSS scale to facilitate early recognition; the ROSIER scale is highly sensitive and specific for stroke recognition, and the scale evaluation items include posterior circulation related symptoms However, due to the lack of targeted research on PCI recognition, the clinical applicability of this scale for early PCI recognition remains to be discussed.
It should be noted that all scales have limitations and cannot be easily diagnosed based on the results of a single scale.
For PCI, the comprehensive evaluation of neurological examination should be further improved.
Yimaitong is compiled from: Quality Control Group of Hubei Stroke Prevention and Treatment Center.
Expert consensus on early recognition and evaluation of acute posterior circulation ischemic stroke[J].
Stroke and neurological diseases , 2021, (28) 2.