Grading scales

Question 1

Hunt & Hess?

Answer 1

Describes the clinical severity of subarachnoid haemorrhage resulting from the rupture of an intracerebral aneurysm and is used as a predictor of survival.

• grade 1: asymptomatic or minimal headache and slight neck stiffness; 70% survival
• grade 2: moderate to severe headache; neck stiffness; no neurologic deficit except cranial nerve palsy;60% survival
• grade 3: drowsy; minimal neurologic deficit; 50% survival
• grade 4: stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances; 20% survival
• grade 5:deep coma; decerebrate rigidity; moribund;10% survival

Question 2

ASIA disability grade for SCI?

Answer 2

A standard method of assessing the neurologic status of a person who has sustained a spinal cord injury.

A Complete: No motor or sensory function is preserved in the sacral segments S4-S5.

B Incomplete: Sensory, but not motor function, is preserved below the neurologic level and includes the sacral segments S4-S5.

C Incomplete: Motor function is preserved below the neurologic level, and more than half of key muscles below the neurologic level have a muscle grade less than 3.

D Incomplete: Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more.

E Normal: motor and sensory function are normal.

Question 3

WFNS grading?

Answer 3

The scale reflects that the biggest determinant of mortality is conscious state, whilst the predictor of morbidity is the presence of hemiparesis or aphasia 4.

grade I: GCS 15
grade II: GCS 13-14, without focal neurological deficit
grade III: GCS 13-14, with focal neurological deficit
grade IV: GCS 7-12
grade V: GCS 3-6

Question 4

Fisher grade?

Answer 4

Discription of blood on CT in SAH. Determines the risk of spasm

1. No subarachnoid blood detected
2. Diffuse or vertical layers <1mm thick
3. Localized clot or/and vertical layers ≥1mm
4. Intracerebral or intraventricular clot with diffuse or no SAH

Question 5

Spetzler-Martin grade?

Answer 5

The Spetzler-Martin arteriovenous malformation (AVM) grading system allocates points for various angiographic features of intracranial arteriovenous malformations to give a score that predicts the morbidity/mortality risk of surgery 5.

size of nidus
small (<3 cm) = 1
medium (3–6 cm) = 2
large (>6 cm) = 3
eloquence of adjacent brain
non-eloquent = 0
eloquent = 1
venous drainage
superficial veins only = 0
deep veins = 1

Question 6

Lawton-Young score?

Answer 6

The following points are added to the Spetzler-Martin grade:

age at resection
<20 years = 1
20–40 years = 2
>40 years = 3

bleeding prior to resection
yes (ruptured) = 0
no (unruptured) = 1

compactness of the arteriovenous malformation nidus
yes (compact) = 0
no (diffuse) = 1

Question 7

Borden classification?

Answer 7

Classification of dAVF:

Question 8

Cognard classification?

Answer 8

Classification of dAVF:

Picture +:
3. Direct venous retrograde
4. Direct venous retrograde with dilated veins
5. Direct venous retrograde to spinal veins

Question 9

Barrow grade?

Answer 9

Carotid-cavernous fistula grade:

Question 10

ODI - Oswestry Disability Index

Answer 10

For lumbar/spine pain and disability scoring.
0-20% Works
>30% May not work
<60% Pain main problem
>60% Disability beyond mere pain

Question 11

House-Brackmann?

Answer 11

For facial nerve function:

Question 12

Koos grading?

Answer 12

For vestibular schwannomas:

Classification

grade 1: small intracanalicular tumour
grade 2: small tumour with protrusion into the cerebellopontine cistern (CPA); no contact with the brainstem
grade 3: tumour occupying the cerebellopontine cistern with no brainstem displacement
grade 4: large tumour with brainstem and cranial nerve displacement

Question 13

Knosp-grading?

Answer 13

Pituitary tumour extension grading:

Question 14

ICH-score?

Answer 14

Question 15

Wiltse classification

Answer 15

Spondylolisthesis grading