E-125 Gaze weakness neglect and speech (GWNS): an acute ischemic stroke scale of large vessel occlusion (LVO) in the emergency department for faster treatment. (23rd July 2022)

• Record Type: Journal Article
• Authors: Lodi, Y; Pande, R; Khan, I
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A144
• Page End: A144
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.236
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introductions: Despite the advancement in acute ischemic stroke (AIS) with LVO, golden time is lost in assessing using NIHSS in the emergency department (ER). CTA to identify LVO requires additional time and resources and exposure of radiation and contrast delaying in perfusion therapy. A simple acute ischemic stroke scale (AISS) of cortical representations in anterior circulation that will rapidly predict LVO, cutdown time and initiate early mechanical thrombectomy (MT) is ideal. We proposed an AISS as GWNS, which can be performed in few minutes and detects LVO. Objective of our study is to evaluate the feasibility and accuracy of GWNS an AISS for the detection of LVO in the ER, which will reduce delay and avoid unnecessary exposure of radiation. Methods: An Institutional review board's permission was obtained and patient enrollment began in January 2020 and still enrolling. From the database, consecutive patients from January 2020 to September 2021 were selected. In GWNS scale, each receives 1 if positive and 0 if negative and scale ranges from 0 to 4. G represents either gaze deviation or gage preference, W represents presence of any weakness, N represents presence of any neglect/disregards and S any speech impairment as aphasia or dysarthria. GWNS scale was utilized by fellowship train stroke and neuroendovascular specialist during triage in ER. In addition to GWNS and NISSS, patients' demographics including CTA/cerebral angiographic data were collected. Data was analyzed by a biostatistician to determine the association of GWNS scale score and LVO. Results: 109 patients (52% women) with age 70.32 plus-minus 15 with median GWNS 3 (range 1–4) and median NIHSS 12 (range 1–27) were enrolled within 24 hours of onset with median ASPECT 9 (range 4–10) who received CTA during triage based on the suspicion of LVO. Time to obtain GWNS was 1.5 minutes (range 1 -3) and CTA was 41.3 plus-minus 7.4 minutes (29 to 51). 58 patients, who had GWNS 3 or 4 had LVO except one who presented with seizure. Of 57 LVO patients, 55 had either gage deviation/preference in addition to weakness and/or speech impairment, but only 46 patient had neglect/disregards, meaning 11 patients with LVO did not have neglect. Right hemispheric LVO was associated with neglect. None of the patient without gage and/or neglect who only had weakness and/or speech impairment had LVO. GWNS score were able to predict LVO better (ROC 0.85) than NIHSS (ROC 0.67) irrespective of the involvement of right or left. GWNS score 3/4 with Gage predicted the most for LVO (ROC 0.9). Conclusions: GWNS is an AISS of LVO which could be performed rapidly in ER. GWNS score 3 and 4 are associated with LVO, especially when gage deviation/preference are present. Additionally, GWNS scale was superior to NIHSS to detect LVO. Therefore, patients with AIS with GWNS score 3 or 4 could be directly send for early MT which will save time and millions of brain cells. Further studies are needed and we are moving to direct GWNS to thrombectomy without CTA in our next phase. Disclosures: Y. Lodi: None. R. Pande: None. I. Khan: None.