The Utility of Quantifiable Neurologic Assessments After Stroke

In the most recent edition of The Neurohospitalist, Marsh and colleagues reported a significant limitation of serial National Institutes of Health Stroke Scale (NIHSS) assessments in patients with acute ischemic stroke.1 The investigators rightfully concluded that an improvement in 4 points on the NIHSS was less sensitive for detecting neurologic recovery when compared to a comprehensive neurologic examination. Recognition of this weakness is pertinent to all clinicians who rely on the NIHSS to identify neurologic recovery (or worsening), especially when using a prethresholded NIHSS improvement in the definition of recovery