Rankin Scale, modified

FIGURE 3.2 Differences between IV rt-PA and placebo-treated patients on four assessment scales using data taken from part II of the 1995 NINDS trial. Values do not total 100% because of rounding. The odds ratio for a global favorable outcome with intravenous rt-PA was 1.7 (95% Cl 1.2-2.6, p = 0.008). The global favorable outcome was defined as NIHSS, 0-1 Barthel Index, 95-100 modified Rankin Scale, 0-1 and Glasgow Outcome Scale, 5. 

FIGURE 5.2 Clinical outcome of patients in the double-blind, proof-of-concept trial evaluating EPO in acute stroke, (a) Barthel Index (rhEPO vs. placebo, p < 0.05). (b) Modified Rankin Scale (rhEPO vs. placebo, p < 0.07) on day 30. Dead patients received the worst possible score. Evolution of lesion size of patients in the efficacy trial of Albumin in acute stroke, ((a-1) and DWI and (a-2) FLAIR.) (Reprinted with permission from reference 50.)... 

FIGURE 5.3 Continued) (b) Distribution of modified Rankin Scale (mRS) scores at 3 months in the lower (I-III) and higher (IV-VI) albumin dose tiers for the rt-PA and non-rt-PA cohorts. (Reprinted with permission from reference 57.)... 

Specific predictive factors for outcome after surgical intervention have not been well defined in the literature. In one prospective, multicenter observational study of 95 patients, the state of consciousness was the only predictive factor retained in a logistic regression analysis." In this study, there was a 2.8-fold increased risk for poor outcome for each increase on a three-step scale (awake/drowsy, somnolent/ stuporous, and comatose), and good outcomes (modified Rankin Scale score <2) were achieved in 86%, 76%, and 47% of patients within each group, respectively. 

Institutes of Health Stroke Scale (NIHSS) at assessment of < 3 (Wityk et al. 1994) or a score of < 2 on the modified Rankin Scale (mRS) at 1 month. Such distinctions are problematic because the NIHSS score will vary with time after the stroke and the mRS at 1 month may increase if a minor stroke is followed by a major stroke. We take the pragmatic view that minor stroke includes those strokes mild enough for patients to be seen in an emergency outpatient setting or to be sent home after initial assessment and treatment in hospital. 

The Life Long After Cerebral Ischemia (LILAC) study reported near complete follow-up on 2473 participants from the Dutch TIA Trial (van Wijk et al. 2005). Mean age was 65 years and 759 had a TIA while the remainder suffered a minor stroke (defined as a score on the modified Rankin scale < 3) at enrolment. The trial recruited patients between 1986 and 1989, all of whom were assessed by a neurologist and randomized to two different dosages of aspirin. After a mean follow-up of 10.1 years, 1489 (60%) had died and 1336 (54%) had suffered at least one vascular event. At 10 years, the cumulative risk of recurrent stroke was 18.4% (95% Cl, 16.7-20.1), of first major vascular event was 44.1% (95% Cl, 42.0-46.1) and of death was 46.6% (95% Cl, 44.2-51.3). The corresponding figures for those presenting with TIA at inception (as opposed to minor stroke) were 35.8% (95% Cl, 32.3-39.3) for first vascular event and 34.1% (95% Cl, 30.7-37.4) for death. The 10-year risk of stroke... 

The objective, clinical assessment of the stroke patient is important for therapeutic decisions and prognosis. The most valuable instrument during the acute stroke period is the NIH stroke scale, which is listed in Table 11.7. Two other commonly used clinical stroke scales to assess premorbid functioning or long-term functional recovery are the Modified Rankin Scale (Table 11.8) and the Barthel Index (Table 11.9). 

Fig. 12.4 Relative distribution of stroke types and goal of treatment. Between 25 and 35% of acute ischemic strokes are major, characterized by NIHSS of 10 or greater due to occlusion of a major cerebral artery that produces a large infarction. Outcomes without treatment are usually poor with modified Rankin scale of 3 or greater. Minor strokes have mild symptoms (NIHSS <10) and are caused by an occlusion of a distal, small branch artery. These result in small infarcts and usually a good outcome (modified Rankin of 0-2) with or without treatment. Lacunar infarcts have similar good outcomes. A major goal of current treatments is to convert major strokes into minor strokes...

ISAT was a randomised, prospective, international, controlled trial of endovascular coiling vs surgical clipping for a selected group of patients with ruptured intracranial aneurysms deemed suitable for both types of therapy. Most patients were treated at high-volume centres in the United Kingdom, with the remainders from other European countries, Australia, Canada, and the United States. The primary endpoint was patient outcome, defined as a modified Rankin scale of 3-6 (dependent or deceased) at 1 year. The primary hypothesis was that endovascular treatment would reduce the proportion of patients dependent or deceased by 25% at 1 year. A total of 9559 patients with SAH were screened... 

Cardiovascular A meta-analysis and systemic review were performed to ascertain the relationship between prior warfarin use with subtherapeutic international normalized ratio (INR) and outcome after intravenous or intraarterial thrombolytic therapy in acute ischaemic stroke patients The outcomes were symptomatic intracranial haemorrhage, modified Rankin scale score and mortality. The risk of symptomatic intracranial haemorrhage after thrombolytic therapy was increased in patients using warfarin with subtherapeutic INR levels. However, there was no association between prior warfarin therapy and worsened fxmctional outcome or all-cause death. 

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