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: ,
