Objective:

The objective was to create a scoring system that could be used as an add on to the National Institutes of Health Stroke Scale (NIHSS) to allow for assessment of posterior fossa strokes while focusing on improving issues in current scoring systems.

Background:

The NIHSS is a widely used tool for assessing the severity of stroke. Its application and value, however, in posterior fossa strokes presents challenges as it does not thoroughly evaluate cerebellar signs or brainstem symptoms. Symptoms such as vertigo and visual disturbances may not be well assessed by the NIHSS. However, current scales made to assess posterior fossa strokes, have their own limitations as well.

Design/Methods:

A literature review of peer-reviewed publications via PubMed was conducted to identify clinical signs and symptoms associated with posterior fossa strokes and any existing posterior fossa stroke scales. Each section chosen was defined with a binary or graded scoring system to reduce subjectivity. The scoring system was discussed with a panel of 5 vascular fellowship-trained neurologists and neuro-ophthalmologist for modification to its end result.

Results:

The Peoria Posterior Fossa Stroke Scale (PPFSS) was made as an add-on to the NIHSS, and therefore, anything examined in the NIHSS was excluded in the PPFSS such as motor strength testing. Both scoring systems should be used in the situation of a suspected or confirmed posterior fossa stroke. The PPFSS consists of a 6-section scoring system with a range of scores of 0 to 15 for use in the acute stroke setting. Sections include Eyes, Nystagmus, Head Impulse, Hearing, Pharynx, and Balance.

Conclusions:

The PPFSS is a proposed framework developed as a potential usable scale at bedside in the acute stroke setting that is ready for validation research study.