The Choice Of Rating Scales For Ischemic Stroke Subtypes According To The TOAST Criteria And Related Research

Objective: To choose suitable neurological deficit clinical rating scales for ischemic stroke subtypes according to the TOAST criteria, and study on the topic of TOAST criteria, simultaneously.Methods: 1. Based on the TOAST criteria, 289 ischemic stroke patients were classified into five major ischemic stroke subtypes: Large-artery atherosclerosis (LAA), Cardioe–mbolism (CE), Small-artery occlusion (SAO), Stroke of other determined cause (OC), and Stroke of undetermined cause (UND). The constituent ratio and prognosis including motality and relapse rate of five subtypes were compared and analyzed. 2. According to the TOAST criteria , the young patients (< 45 years old) in 289 ischemic stroke patients were researched in etiopathogenisis and risk factors of ischemic stroke. 3. Five stroke scales were used to evaluate each subtype. The five stroke scales were the NIH Stroke Scale (NIHSS), the Modified Edinburgh-Scandinavian Stroke Scale (MESSS), the Unified Form for Neurological Stroke Scale (UNSS), the Canadian Neurological Scale (CNS) and the European Stroke Scale (ESS). Predictive validity was assessed by correlative analysis between their scores and the Barther Index (BI) at the end of the third month after onset.Inter-tester reliability was analyzed by the value of Kappa. Acceptability was evaluated by average scale-assessing time.Results: 1. The constituent ratio of TOAST subtypes was as follows: the highest constituent ratio was UND (36.6%), the second was SAO (29.8%), the lowest was OC (1.7%). 2. Mortality at the end of the third month after onset was as follows: CE was 15.5%, which was the highest. LAA was 11.8%, SAO was the lowest (1.2%). Recurrence rate at the end of the third month after onset was as follows: LAA was the highest (17.6%), the second was CE (8.6%), SAO was the lowest (2.4 %). 3. The constituent ratio of TOAST subtypes in young ischemic stroke patients was as follows: the highest was UND (43.5%), the second was LAA (21.7%), the lowest is OC (4.3%). 4. For LAA, MESSS had the highest validity, For CE, ESS had the highest validity, For UND and SAO, NIHSS had the highest validity.While CNS had the highest reliability and acceptability for LAA, CE, UND and SAO. Because of the small number of samples, OC could not be analyzed.Conclusions: 1. In the constituent ratio of TOAST subtypes, UND was the highest, OC was the lowest. SAO was the highest in Stroke of determined cause. 2. TOAST criteria was useful for evaluated the prognosis of stroke. 3. In this study, we found that early atherosclerosis was the major cause of young ischemic stroke. 4. In TOAST subtypes of ischemic stroke, MESSS is the most suitable scale for LAA, ESS is the most suitable scale for CE, NIHSS is the most suitable scale for UND, and NIHSS is the most suitable scale for SAO.