An endovascular procedure-specific neurological examination scheme for intraprocedural monitoring in awake patients

Purpose: To describe a new neurological examination scheme (NES) adapted to the unique environment of neuroendovascular procedures. Methods: The endovascular procedure-specific (NES) evaluates 6 aspects of neurological function, including language, gaze deviation, visual fields, cranial nerves, and the function of the upper lower extremities (left and right). To evaluate this protocol, the results of neurological examinations based on the NES were compared to the concurrently assessed National Institutes of Health Stroke Scale (NIHSS) scores in 20 patients (11 men; mean age 47±18 years) during neuroendovascular procedures. All examinations were performed by qualified vascular neurologists certified for NIHSS score ascertainment in awake patients undergoing any neuroendovascular procedures. The positive predictive value and Spearman rank correlation coefficient were determined to assess the relationship between the 2 scores in the study sample. Results: The positive predictive value of endovascular procedure-specific NES compared with the NIHSS score was 100%. The deficits most frequently detected by the endovascular procedure-specific NES were in the cranial nerves and upper and/or lower extremity strength items. Overall, the Spearman rank correlation coefficient was 0.96 (p<0.001) between both methods. In a subset analysis of patients with deficits detected by NIHSS, the correlation coefficient between the 2 methods was 0.95 (p<0.001). Conclusion:No standard method has been developed for examining the neurological status of the awake patient under the unique intraprocedural circumstances that surround neuroendovascular procedures. The NES detected neurological deficits with a high level of agreement to the more detailed NIHSS assessment, which supports further evaluation of the NES.