ArticleFrontiers in neuroscience2026
Infarction volume modulates and corrects left hemisphere bias in the NIHSS for middle cerebral artery stroke.
Article in Frontiers in neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: The National Institutes of Health Stroke Scale (NIHSS) exhibits a left hemisphere bias in middle cerebral artery (MCA) stroke. This study aimed to quantify this bias, investigate its modulation by infarction volume, and develop a correction model. Methods: This retrospective study included 263 first-ever MCA stroke patients, with 173 in the training set and 90 in the test set. Baseline NIHSS scores were compared between left and right hemispheric stroke before and after propensity score matching. Negative binomial regression tested the interaction between infarction side and volume on NIHSS scores in the training set. A correction was then applied to NIHSS scores for left hemisphere strokes. Correction effectiveness was verified by comparing interhemispheric difference in before and after corrected scores, correlation with infarction volume and predictive value for hemorrhagic transformation (HT). Results: Left hemisphere stroke had higher NIHSS scores than right before and after matching, both in the training and test sets ( Conclusion: Infarction volume modulates the left hemisphere bias of the NIHSS scores in MCA stroke. The infarction volume-based correction eliminates this bias, strengthens biological validity, and improves the prediction of clinically relevant outcomes like HT.
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