The Canadian Neurological Scale and Stroke Assessment System (SAS) can be used to evaluate a patient with an acute stroke. It can be used to monitor the patient over time. The authors are from McGill, Western Ontario and Toronto Universities.
Patient selection: The patient is alert or drowsy. A patient who is stuporous or comatose should be monitored using the Glasgow Coma Scale.
Measures:
(1) mentation
(2) motor function
Mentation measures:
(1) level of consciousness
(2) orientation
(3) speech
Motor function measure for the patient with no comprehension defect (Section A1 – for patients with speech normal or showing an expressive deficit):
(1) facial muscle weakness
(2) proximal arm weakness
(3) distal arm weakness
(4) leg weakness
Motor function measure for the patient with a comprehension defect (Section A2 – for patients with speech showing a receptive deficit):
(1) symmetry of facial motor response
(2) muscle strength in arms
(3) muscle strength in legs
NOTE: The specific steps for each measure are given in the Appendix on pages 735-737, Cote et al. 1986.
Mentation Measure |
Finding |
Points |
level of consciousness |
alert |
3 |
|
drowsy |
1.5 |
orientation |
oriented to place and time |
1 |
|
disoriented or not-applicable |
0 |
speech |
normal |
1 |
|
expressive deficit |
0.5 |
|
receptive deficit |
0 |
Motor Function Section A1 |
Finding |
Points |
facial muscle weakness |
none |
0.5 |
|
present |
0 |
proximal arm weakness |
none |
1.5 |
|
mild |
1 |
|
significant |
0.5 |
|
total |
0 |
distal arm weakness |
none |
1.5 |
|
mild |
1 |
|
significant |
0.5 |
|
total |
0 |
leg weakness |
none |
1.5 |
|
mild |
1 |
|
significant |
0.5 |
|
total |
0 |
Modification of Cote et al (1989): The leg motor function for Section A1 was expanded into proximal and distal leg weakness, each with 1.5 maximum points. This would give 11.5 as the maximum total score.
Motor Function Section A2 |
Finding |
Points |
facial muscle response |
symmetrical |
0.5 |
|
asymmetrical |
0 |
muscle strength in arms |
equal |
1.5 |
|
unequal |
0 |
muscle strength in legs |
equal |
1.5 |
|
unequal |
0 |
mentation subscore =
= SUM(points for the 3 mentation measures)
motor function subscore =
= SUM(points for the muscle function measures)
total score =
= (subscore for mentation) + (subscore for motor function)
Interpretation:
• minimum mentation subscore: 1.5
• minimum motor function subscore: 0
• minimum total score: 1.5
• maximum mentation subscore: 5
• maximum motor function subscore for section A1: 5
• maximum motor function subscore for section A2: 3.5
• The maximum total score is 10.
• The higher the score the better the patient's condition.
• A change in the score >= 1.0 points had a sensitivity of 0.93 and specificity of 0.51 for detecting a clinical change in the patient, with a negative predictive value of 0.97 (Table 6, Cote et al, 1989).
Performance:
• The kappa score for the global score was 0.888, indicating good interobserver reliability.
Specialty: Neurology
ICD-10: ,