Conclusion: The addition of line cancellation and visual perception tasks significantly adds to the model of NIHSS alone in predicting DWI volume. We propose that these two cognitive tests, which together can be completed in 2–3 minutes, could be combined with the NIHSS to create an "NIHSS-plus" that more accurately represents a patient's ischemic tissue volume after a stroke. This scale requires further validation in a prospective study.
F, G. R., T, K. J., Cameron, D., Jennifer, H.-G., Melissa, N., & E, H. A. (2009). The NIHSS-Plus: Improving cognitive assessment with the NIHSS. Behavioural Neurology, (1,2), 11–15. https://doi.org/10.3233/BEN-2009-0259