国立卫生研究院脑卒中评定标准（NIHSS）为0分的急性脑卒中
翻译：江利冰 校对：肖锋

Title: Acute Stroke with NIHSS Score of 0

题目：国立卫生研究院脑卒中评定标准（NIHSS）为0分的急性脑卒中

Author 作者: EMedHome.com
In an era in which Emergency Physicians are under significant pressure to rapidly evaluate for acute ischemic stroke, this clinical pearl serves as a reminder that the National Institutes of Health Stroke Scale (NIHSS) alone cannot be used to rule out a stroke in patients with acute persistent symptoms.
在要求对缺血性脑卒中做出快速评估的年代，急诊科医师仍然面临着很大的压力。这个临床必知将提醒临床医师，持续伴有临床症状的患者单独使用国立卫生研究院脑卒中评定标准（NIHSS）不能排除脑卒中的诊断。
Ischemic stroke may cause symptoms that are not captured by the NIHSS scale.
缺血性脑卒中可能引起NIHSS无法囊括的症状。
The NIHSS scale is highly weighted toward deficits caused by anterior circulation strokes, whereas deficits caused by posterior circulation strokes receive fewer points.
NIHSS侧重于前脑循环脑卒中引起的缺血，对于后脑循环脑卒中引起的缺血则赋予较少的分值。
Within the anterior circulation, the scale underestimates the degree of right versus left hemisphere injury.
在前脑循环中，和左侧大脑半球损伤相比评定标准低估了右侧大脑半球的损伤。
It is possible that some patients with persistent symptoms on arrival to ED and an NIHSS score of 0 still have an infarct.


可能会出现这种情况，一些来到急诊科的患者持续伴有临床症状，虽然NIHSS评分为0，仍然可能存在梗塞。
In a 2011 study, stroke patients with an NIHSS score of 0 most commonly presented with nausea, vomiting, and headache, all of which are associated with posterior circulation ischemia.
2011的一项研究，伴有NIHSS评分0分的脑卒中患者经常会出现恶心，呕吐，以及头痛的症状，这些症状均和后脑循环缺血有关。
Midline lesions of the cerebellum cause truncal ataxia, which is not part of the NIHSS.
NIHSS 中也不包括小脑中线病变引起的共济失调。
In addition, decreased visual acuity, Horner's syndrome, and memory impairments are neurologic deficits not captured by the NIHSS.
除此之外，视力减退，霍纳氏综合征以及记忆力减退等神经功能的缺损，均没有囊括在NIHSS中。

Subtle limb weakness (4/5) in an upper motor neuron pattern (extensors of the arms or flexors of the legs) may not be observed on the motor component of the NIHSS. 


上运动神经元受损（上肢的伸肌或者下肢的屈肌）引起轻微的肢体功能减退（4/5），在NIHSS的运动部分指标可能观察不到。
References 参考文献:

Martin-Schild S, et al. Ann Emerg Med 2011 Jan;57(1):42-5.

Libman RB, et al. Cerebrovasc Dis 2001;11:311-316.

Sato S, et al. Neurology 2008;70:2371-2377.

Fink JN, et al. Stroke 2002;33:954-958.