Validity and Reliability of Neurological Scores in Mice Exposed to Middle Cerebral Artery Occlusion

Abstract

Background and Purpose— The selection of appropriate neurological scores and tests is crucial for the evaluation of stroke consequences. The validity and reliability of neurological deficit scores and tests has repeatedly been questioned in ischemic stroke models in the past. Methods— In 198 male mice exposed to transient intraluminal middle cerebral artery occlusion, we examined the validity and reliability of 11 neurological scores (Bederson score 0–3, Bederson score 0–4, Bederson score 0–5, modified neurological severity [0–14], subjective overall impression [0–10], or simple neurological tests: grip test, latency to move body length test, pole test, wire hanging test, negative geotaxis test, and elevated body swing test) in the acute stroke phase, that is, after 24 hours. Combinations of neurological scores or tests for predicting infarct volume were statistically analyzed. Results— Infarct volume was left skewed (median [Q1–Q3], 78.4 [54.8–101.3] mm 3 ). Among all tests, the Bederson (0–5; r=0.63, P <0.001), modified neurological severity (r=0.80, P <0.001), and subjective overall impression (r=−0.63, P <0.001) scores had the highest test validities, using infarct volume as external reference. Subjective overall impression had the best agreement between 5 raters (Kendall W=0.11, P <0.001). The Bederson (0–5) score discriminated infarct volume in mice with small (≤50 mm 3 ; r=0.33, P =0.027) and large (>50 mm 3 ; r=0.48, P <0.001) brain infarcts, all other tests only in mice with large infarcts. Combining subjective overall impression with Bederson (0–5) score explained 47.6% of the variance of infarct volume. Conclusions— Despite their simplicity, the Bederson (0–5) score, modified neurological severity score, and subjective overall impression have reasonable validity and reliability in the acute stroke phase. The Bederson (0–5) score equally distinguishes infarct volume in small and large infarcts. Visual Overview— An online visual overview is available for this article.

Characterization of a novel model of global forebrain ischaemia–reperfusion injury in mice and comparison with focal ischaemic and haemorrhagic stroke

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“… 25 – 27 For assessment of the long-term neurological outcome, the occlusion time was reduced to 30 minutes, and Bederson score, modified neurological severity score, corner test, body swing test, grip test, latency to move, and adhesive tape removal test were performed daily as described previously. 28 …”

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“…To evaluate neurological functional outcome after stroke and the therapeutic efficacy of VT treatment, all rats were subjected to modified neurological severity score (mNSS) testing on days 1, 7, and 14 after MCAo, conducted by an investigator blinded to the experimental groups. The mNSS test is widely used to evaluate neurological function following brain injury in rodents and is a composite of motor, sensory, balance, and reflex tests 25 . The absence of a tested reflex or abnormal response is scored as one point.…”