In this page you’ll find some helpful scales and scores we use in Neurology:
 

Medical Research Council (MRC) Grading of Power:

• 0: no visible or palpable movement
• 1: flicker of voluntary movement
• 2: movement with gravity eliminated
• 3: movement against gravity but not against resistance
• 4: movement against gravity & resistance, but not full strength
• 5: normal

 

Classification of muscle stretch reflexes:

• 0= absent
• += reduced
• ++= normal
• +++= increased
• ++++= very increased, usually with clonus

 

Glasgow Coma Scale (GCS)

Observe the patient, then give verbal and painful stimuli. Grade the eye opneing, verbal and motor response. Score ranges from 3-15.
Eye Opneing:
4 Spontaneous
3 To sound
2 To pressure
1 No response
Verbal Response:
5 Orientated
4 Confused
3 Words
2 Sounds
1 No response
Motor Response:
6 Obey commands
5 Localising
4 Normal flexion
3 Abnormal flexion
2 Extension (extensor posturing)
1 No response
 

Modified Rankin Scale:

Modified Rankin Scale (mRS):
0	No disability
1	No significant disability despite symptoms; able to carry out all usual duties and activities
2	Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
3	Moderate disability; requiring some help, but able to walk without assistance.
4	Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
5	Severe disability; bedridden, incontinent and requiring constant nursing care and attention.
6	Death

References:

1. Rankin J. Scott Med J1957
2. Bonita R, et al Stroke1988
3. Van Swieten JC, et al Stroke1988
4. Wilson JT et al. Stroke 2005
5. Wilson JT et al. Stroke 2002

 

Modified TICI – Thrombolysis In Cerebral Infarction

TICI Score	Definition
TICI 0	No Reperfusion
TICI 1	Flow beyond occlusion without distal reperfusion
TICI 2a	Reperfusion of <half of downstream target arterial territory
TICI 2b	Reperfusion of >half, yet incomplete, in the downstream target arterial territory
TICI 3	Complete reperfusion, of downstream target arterial territory, including distal branches with slow flow

This relates to capillary-level reperfusion as measured on catheter angiography
References:

1. Wintermark M et al. Stroke. 2013 Sep;44(9):2628-39.
2. Higashida & Furlan Stroke 2003;34;e109-e137

 
 

TIBI grade, Thrombolysis In Brain Ischemia grade

As measured on transcranial doppler ultrasound

TIBI grade	Features	Comment
0= Absent	Absent flow= lack of regular pulsatile flow despite varying background noise
1= Minimal	Systolic spikes of variable velocity and duration Absent end diastolic flow during all cardiac cycles based on visual interpretation of no flow during end diastolic (reverberating flow is a subtype)	TCD equipment may report velocities erroneously due to noise artefacts (visual inspection is needed)
2= Blunted	Flattened/Slow systolic flow acceleration Positive end diastolic velocity Pulsatility index PI <1.2	-Usually MFV decreased by >20% compared to contralateral
3= Dampened	Normal systolic flow acceleration Positive end diastolic velocity decreased MFV by =or>30% compared to control	-visually have more pulsatile shape (triphasic) -downslope of systole is sharp
4= Stenotic	MFV=or>80cm/s AND MFV difference =or>30% compared to control OR if both are affected and comparison has MFV<80cm/s, use MFV difference =or>30% compared to control AND signs of turbulence
5= Normal	<30% MFV difference compared to control Similar waveform compared to control	-HTN can cause symmetric high resistance signals with PI=or>1.2 and low end diastolic flow

Reference:

1. Demchuk AM, et al. Thrombolysis in Brain Ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patient treated with intravenous tissue plasminogen activator. Stroke. 2001; 32: 89–93

 

WASID intracranial stenosis criteria

50% stenosis by WASID criteria

• Measure the diameter of the residual lumen
• Measure the normal reference diameter (one of the following in descending order of preference):
  • 1 Same artery proximal to the stenosis
  • 2 Same artery distal to the stenosis
  • 3 Feeding artery
• % stenosis= [1-(residual lumen/normal diameter)]X 100

The location has to have normal vessel segment with parallel walls free of atherosclerosis
Good interobserver and intraobserver agreements
Reference:

1. Samuels OB, et al. AJNR Am J Neuroradiol2000; 21:643–4

 

Hemorrhagic conversion after thrombolysis

Grade	Description
HT1, Hemorrhagic transformation 1	Small petechiae
HT2, Hemorrhagic transformation 2	More confluent petechiae
PH1, Parenchymal hematoma 1	≤30% of the infarcted area with some mild space-occupying effect
PH2, Parenchymal hematoma 2	>30% of the infarcted area with significant space-occupying effect or clot remote from infarcted area

Reference:

1. M Fiorelli et al. Stroke. 1999 Nov;30(11):2280-4.

 

ASPECTS score

Reference:

1. Barber PA, Demchuk AM, Zhang J, and Buchan AM, Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000; 355: 1670-4.
2. http://www.aspectsinstroke.com/

 

Posterior circulation ASPECTSPc-ASPECTS

• 10= normal
• Subtract 1-2 for each area with hypoattentuation on CT or restricted diffusion on MRI
  • 1 point: left or right thalamus, cerebellum or PCA-territory, respectively
  • 2 points: any part of midbrain or pons

 
Reference:

1. Puetz V et al. Stroke. 2008;39:2485-2490

 

Multiphased CTA:

Score	Multiphased CTA
5	When compared with the asymptomatic contralateral hemisphere, there is no delay and normal or increased prominence of pial vessels/normal extent within the ischemic territory in the symptomatic hemisphere
4	When compared with the asymptomatic contralateral hemisphere, there is a delay of one phase in filling in of peripheral vessels, but prominence and extent is the same
3	When compared with the asymptomatic contralateral hemisphere, there is a delay of two phases in filling in of peripheral vessels or there is a one-phase delay and significantly reduced number of vessels in the ischemic territory
2	When compared with the asymptomatic contralateral hemisphere, there is a delay of two phases in filling in of peripheral vessels and decreased prominence and extent or a one-phase delay and some ischemic regions with no vessels
1	When compared with the asymptomatic contralateral hemisphere, there are just a few vessels visible in any phase within the occluded vascular territory
0	When compared with the asymptomatic contralateral hemisphere, there are no vessels visible in any phase within the ischemic vascular territory

Reference:

1. Menon BK, d’Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, and Goyal M, Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology 2015: 142256.

 

ABC/2 score for ICH volume:

Hemorrhage volume= ABC/2

• Where A is the greatest hemorrhage diameter in cm
• B is the diameter 90° to A
• C is the approximate number of CT slices with hemorrhage multiplied by the slice thickness in cm

References:

1. Broderick et al. Stroke 1993;24:987-993
2. Kothari RU. Stroke. 1996;27:1304-1305

 

ICH score:

Add scores for the follwoing parameters:

• Glasgow coma scale
• Age ≥ 80
• ICH Volume ≥ 30ml
• Presence of intraventricular hemorrhage IVH
• Infratentorial origin of hemorrhage

 
Glasgow Coma Score:

• +2 points for GCS 3-4
• +1 points for GCS 5-12
• 0 points for 13-15

Age ≥ 80

• 1 point for YES
• 0 points for NO

ICH Volume ≥ 30ml

• 1 point for YES
• 0 points for NO

Intraventricular Hemorrhage

• 1 point for YES
• 0 points for NO

Infratentorial Origin of Hemorrhage

• 1 point for YES
• 0 points for NO

Reference:

1. Hemphill et al. Stroke 2001, 32:891-897

 

IVH Scale- Graeb

Reference:

1. Graeb DA, et al. Radiology. 1982  pr;143(1):91-6.

 

Hydrocephalus score – Diringer method:

The system grades each of 8 portions of the ventricular system independently:

• Frontal horn, atrium, and temporal horn of each lateral ventricle
• Third ventricle
• Fourth ventricle

Each region was graded as:

• 0= none, 1=mild, 2= moderate, or 3= marked

Criteria:

• Frontal horn, rounding with increased radius, decreased ventricular angle, and sulcal effacement of the frontal lobe
• Atria, rounding and enlargement with sulcal effacement of the parieto-occipital lobe
• Temporal horns, increasing width
• Third ventricle, increased width with ballooning of the anterior recess
• Fourth ventricle, ballooning.

The scores summed are summed for 8 areas. Total score:

• 0= no hydrocephalus
• 24= indicates marked hydrocephalus of all ventricles.

References:

1. Diringer et al. Stroke. 1998;29:1352-1357

 

Cerebral Amyloid Angiopathy, CAA:

Boston Criteria for Diagnosis of CAA-Related hemorrhage:
References:

1. Knudsen KA et al. Neurology 2001;56;537

 

Saccular aneurysm treatment coiling result – Raymond grade:

Raymond grade:

1. Complete occlusion
2. Residual neck
3. Residual aneurysm

References:

1. Roy D, Milot G, Raymond J. Stroke 2001; 32: 1998–2004

 

Saccular aneurysm treatment coiling result – Consensus grade:

6 point Consensus grading:

• Grade 0 indicates complete and total aneurysm occlusion without remnant or interstitial filling within the aneurysm. Depending on the coil type used, complete occlusion may or may not be synonymous with complete radio-opacity of the aneurysm lumen because certain coil systems are only partially radio-opaque. Assessment must be made based on the distribution of liquid contrast material during arteriographic acquisitions in 2 optimal orthogonal projections
• Grade 1 represents 90% volumetric occlusion of the aneurysm based on planar imaging assessment
• Grade 2 includes 70% to 89% volumetric aneurysm occlusion
• Grade 3 includes 50% to 69% aneurysm occlusion
• Grade 4 should include 25% to 49% aneurysm occlusion
• Grade 5 represents less than 25% volumetric aneurysm occlusion.

References:

1. Meyers PM, et al. J Neurointerv Surg. 2010 Dec;2(4):312-23
2. Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34(6):1398–1403.

Cerebral Vessel perforation grading:

Diagnosed by documentation of contrast material outside the arterial lumen
Types by location:

• Localized in the tissue immediately surrounding the artery= Intraparenchymal.
• Nonfocally beyond the tissue immediately surrounding the artery= Subarachnoid

Types by symptoms:

• Asymptomatic
• Symptomatic (headache or focal deficits)

References:

1. Schumacher HC et al. Stroke 2009;40:e348-e365;

 

European Quality Of Life (EuroQOL)

References:

1. http://www.euroqol.org/

The Barthel index

References:

1. Barthel D. Maryland State Medical Journal 1965;14:56-61.

Aortic Arch Elongation Classification

Defined by the parallel planes perpendicular to:

• The greater (outer) curvature
• The lesser (inner) curvature of the arch

If the arch vessels arose:

• Type 1 arch, mild angulation: from the top of the arch or outer curvature
• Type 2 arch, moderate angulation: between the two planes
• Type 3 arch, severe angulation: proximal or caudal to the lesser curvature plane of the arch. Or >2cm between plane of greater curvature to origin of brachiocephalic trunk

References:

1. Ann Vasc Surg. 2005;19:798–804
2. J Vasc Surg 2007;45:875-80