Are More Complex Study Designs Needed for Future Acute Stroke Trials?

Abstract
Stroke scales were originally devised to quantify the disturbance in neurological function explained by a stroke-induced brain lesion [1]. Given the century-long experience with the clinical examination and the beliefs in the principles of clinicoanatomical correlation, most of the popular stroke scales were derived directly from the traditional neurological examination. Included in the assessment was, typically, a score to estimate the level of consciousness: uni- or bilateral disturbances in the main sensory and motor systems, and disturbances in so-called higher cerebral functions including speech, language, memory, the patient’s awareness of the extent of the neurological disturbance, and response to stimuli presented on one or other sides of space. Recognizable as the traditional examination, most such scales have been readily accepted by clinical investigators.