Stroke Know the signs
 
     
 

Grading scales

  
 
Some common means of clinical evaluation of various conditions and clinical state in neurological patients are presented. Grading scales allow easy discussion in a common language among medical practitioners.
 
 
 
 

Glasgow Coma Score

 
 
Eye opening 1,2,3,4
  
 
  1. no eye opening
  2. eye open to pain
  3. eye open to speech
  4. eye open spontaneously
  
 
 
 
Verbal response 1,2,3,4,5
  
 
  1. no verbal response
  2. incomprehensible speech
  3. inappropriate speech
  4. confused speech
  5. normal verbal response
  
 
 
 
Motor reaction 1,2,3,4,5,6 (best motor response is recorded, regardless of the side)
  
 
  1. no motor response
  2. extensor response
  3. abnormal flexion
  4. flexor response
  5. localizing to pain
  6. normal response. Obeying commands
 
 
The highest possible score is 15 and the lowest possible score is 3.
GCS 15-13 is good, GCS 12-9 is critical with a high potential to deteriorate, GCS 8-3 is poor with a high risk of death.
  
 
 
 

World Federation of Neurological Surgeons Scale for Subarachnoid Haemorrhage

  
   
 
This is based on the GCS and the finding of aphasia or a motor deficit.
  
 
  1. GCS 15 = good grade
  2. GCS 14-13, with no motor deficit= fair grade
  3. GCS 14-13, with hemiparesis or aphasia = tending to poor grade
  4. GCS 12-8, with or without hemiparesis or aphasia = poor grade
  5. GCS >8, with or without hemiparesis or aphasia = moribund patient
 
     
   
 
 
 

Glasgow Coma Score

 
 
  • Dead: GOS 1
    Vegetative: GOS 2
    Severely disabled: GOS 3
    Moderately disabled: GOS 4
    Good recovery: GOS 5
  
 
 
 
Other very useful scales
  
 
  • National Institute of Health Scale
  • Karnofsky performanceScore
  • Modified Rankin Scale
  
 
 
 
Published Guidelines and rationales on stroke management (not an exhaustive list)
  
 
 
 
  1. Wylie-Rosett J, Mossavar-Rahmani Y, Gans K. Recent dietary guidelines to prevent and treat cardiovascular disease, diabetes, and obesity. Heart Disease. 2002;4:220-230
  2. Peeters A, Cras P, Blecic S. Proposal of guidelines for acute stroke treatment and management. Acta Neurologica Belgica. 2002;102:46-48
  3. Desfontaines P, Vanhooren G, Peeters A, Laloux P. Proposal of guidelines for stroke units. Acta Neurologica Belgica. 2002;102:49-52
  4. National clinical guidelines for stroke: a concise update. Clinical Medicine. 2002;2:231-233
  5. White RH, McBurnie MA, Manolio T et al. Oral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort. American Journal of Medicine. 1999;106:165-171
  6. Swales JD. Current status of hypertensive disease treatment: results from the Evaluation and Interventions for Systolic Blood pressure Elevation: Regional and Global (EISBERG) project. [Review] [11 refs]. Journal of Hypertension - Supplement. 1999;17:S15-19
  7. Olney RS. Preventing morbidity and mortality from sickle cell disease. A public health perspective. [Review] [64 refs]. American Journal of Preventive Medicine. 1999;16:116-121
  8. Koudstaal PJ. Stroke prevention: which drugs to use and when?. [Review] [26 refs]. Journal of Neurology. 1999;246:753-757
  9. Duncan PW, Lai SM, van Culin V et al. Development of a comprehensive assessment toolbox for stroke. Clinics in Geriatric Medicine. 1999;15:885-915
  10. Fodor JG, Whitmore B, Leenen F, Larochelle P. Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ (Canadian Medical Association Journal). 1999;160:S29-34
  11. Broderick JP, Adams HP, Jr., Barsan W et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999;30:905-915
  12. Brockington CD, Lyden PD. Criteria for selection of older patients for thrombolytic therapy. [Review] [38 refs]. Clinics in Geriatric Medicine. 1999;15:721-739
  13. Clark WM, Lutsep HL. Medical treatment strategies: intravenous thrombolysis, neuronal protection, and anti-reperfusion injury agents. [Review] [35 refs]. Neuroimaging Clinics of North America. 1999;9:465-473
  14. Cleroux J, Feldman RD, Petrella RJ. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ (Canadian Medical Association Journal). 1999;160:S21-28
  15. Albers GW, Hart RG, Lutsep HL et al. AHA Scientific Statement. Supplement to the guidelines for the management of transient ischemic attacks: A statement from the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks, Stroke Council, American Heart Association. [see comments.]. Comment in: Stroke. 2000 Apr;31(4):983-4 ; 10754010, Comment in: Stroke. 2000 Apr;31(4):983-4 ; 10836906. Stroke. 1999;30:2502-2511
  16. Schrader J, Rothemeyer M, Luders S, Kollmann K. Hypertension and stroke--rationale behind the ACCESS trial. Acute Candesartan Cilexetil Evaluation in Stroke Survivors. [Review] [61 refs]. Basic Research in Cardiology. 1998;93 Suppl 2:69-78
  17. Norris JW, Buchan A, Cote R et al. Canadian guidelines for intravenous thrombolytic treatment in acute stroke. A consensus statement of the Canadian Stroke Consortium. Canadian Journal of Neurological Sciences. 1998;25:257-259
  18. Loewen P, Sunderji R, Gin K. The efficacy and safety of combination warfarin and ASA therapy: a systematic review of the literature and update of guidelines. [Review] [43 refs]. Canadian Journal of Cardiology. 1998;14:717-726
  19. Gordon MT. Developing clinical guidelines for the management of patients with stroke. Scottish Intercollegiate Guidelines Network (SIGN). International Journal of Language & Communication Disorders. 1998;33 Suppl:152-157
  20. Goldstein LB, Samsa GP, Matchar DB, Oddone EZ. Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis. Stroke. 1998;29:750-753
  21. Broderick JP. Practical considerations in the early treatment of ischemic stroke. [Review] [17 refs]. American Family Physician. 1998;57:73-80
  22. Biller J, Feinberg WM, Castaldo JE et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. [see comments.]. Comment in: Stroke. 1998 Jul;29(7):1475-6 ; 9660406. Stroke. 1998;29:554-562
  23. Bahle J. Stroke prevention screening program. [Review] [10 refs]. Journal of Vascular Nursing. 1998;16:35-37
  24. Anonymous. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. [Review] [4 refs]. Archives of Internal Medicine. 1998;158:1855-1867
  25. Perry JR, Szalai JP, Norris JW. Consensus against both endarterectomy and routine screening for asymptomatic carotid artery stenosis. Canadian Stroke Consortium. [see comments.]. Archives of Neurology. 1997;54:25-28
  26. Marcinczyk MJ, Nicholas GG, Reed JF, 3rd, Nastasee SA. Asymptomatic carotid endarterectomy. Patient and surgeon selection. Stroke. 1997;28:291-296
  27. Kilander L, Boberg M, Lithell H. How do we treat, or not treat, high blood pressure in the oldest old? A practice study in Swedish geriatricians. Blood Pressure. 1997;6:372-376
  28. Forbes SA, Duncan PW, Zimmerman MK. Review criteria for stroke rehabilitation outcomes. Archives of Physical Medicine & Rehabilitation. 1997;78:1112-1116
  29. Findlay JM, Tucker WS, Ferguson GG et al. Guidelines for the use of carotid endarterectomy: current recommendations from the Canadian Neurosurgical Society. CMAJ (Canadian Medical Association Journal). 1997;157:653-659
  30. Cummins RO, Chamberlain D, Hazinski MF et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Resuscitation. 1997;34:151-183
  31. Anonymous. Guidelines for school health programs to promote lifelong healthy eating. [Review] [229 refs]. Journal of School Health. 1997;67:9-26
  32. Rothwell PM, Slattery J, Warlow CP. A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. [Review] [68 refs]. Stroke. 1996;27:260-265
  33. Wood VA, Hewer RL. The prevention and management of stroke. [Review] [72 refs]. Journal of Public Health Medicine. 1996;18:423-431
  34. Anonymous. Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke. 1997;28:2119-2125
  35. Adams HP, Jr., Brott TG, Furlan AJ et al. Guidelines for Thrombolytic Therapy for Acute Stroke: a Supplement to the Guidelines for the Management of Patients with Acute Ischemic Stroke. A statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Stroke. 1996;27:1711-1718
  36. Slyter H. Guidelines for the management of patients with acute ischemic stroke. Stroke. 1995;26:137-138
  37. Rawles J. Guidelines for general practitioners administering thrombolytics. [Review] [45 refs]. Drugs. 1995;50:615-625
  38. Moore WS, Barnett HJ, Beebe HG et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association. [Review] [174 refs]. Stroke. 1995;26:188-201
  39. Nixon J, Bateman DE, Malthouse SR. Computerised tomography scans of the head in a district general hospital. [see comments.]. Journal of the Royal College of Physicians of London. 1996;30:547-550
  40. Anonymous. Guidelines for the management of hypertension at primary health care level. Hypertension Society of Southern Africa, endorsed by the Medical Association of South Africa and the Medical Research Council. [see comments.]. South African Medical Journal. 1995;85:1321-1325
  41. Alberts MJ, Goldstein LB, Smith T. Guidelines on the use of thrombolytic agents in stroke. Jama. 1995;274:218
  42. Mayberg MR, Batjer HH, Dacey R et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994;25:2315-2328
  43. Feinberg WM, Albers GW, Barnett HJ et al. Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association. Circulation. 1994;89:2950-2965
  44. Anonymous. Guidelines for medical treatment for stroke prevention. American College of Physicians. Annals of Internal Medicine. 1994;121:54-55
  45. Anonymous. Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association. [see comments.]. Comment in: Stroke. 1995 Mar;26(3):523-4 ; 7886736. Stroke. 1994;25:1320-1335
  46. Adams HP, Jr., Brott TG, Crowell RM et al. Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. [see comments.]. Comment in: Stroke. 1995 Mar;26(3):522-3 ; 7533952. Stroke. 1994;25:1901-1914
  47. Christenson JM, Solimano AJ, Williams J et al. The new American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: presented by the Emergency Cardiac Care Subcommittee of the Heart and Stroke Foundation of Canada. [see comments.]. Comment in: Can Med Assoc J. 1993 Sep 1;149(5):563-5. CMAJ (Canadian Medical Association Journal). 1993;149:585-590
  48. Fotherby MD, Harper GD, Potter JF. General practitioners' management of hypertension in elderly patients. [see comments.]. Comment in: BMJ. 1992 Nov 7;305(6862):1161 ; 1463970. Bmj. 1992;305:750-752
  49. Anonymous. Stroke. Towards better management. Summary and recommendations of a report of the Royal College of Physicians. Journal of the Royal College of Physicians of London. 1990;24:15-17
  50. Emeriau JP. Guidelines for treating hypertension in the elderly. [Review] [29 refs]. Drugs. 1989;38:612-620
  51. Feigenson JS. Stroke rehabilitation. Outcome studies and guidelines for alternative levels of care. Stroke. 1981;12:372-375
 
 

 

  
   
     
 
Created by B I Ogungbo in September 2002. Modified January 2008. ©