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Neurosurgery > Grading Systems > Flashcards

Grading Systems Flashcards

1
Q

Describe the eye scoring for the Glasgow Coma Scale

A 
4 = open spontaneously
3 = to verbal stimulation
2 = to pain
1 = don't open
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2
Q

Describe the motor scoring for the Glasgow Coma Scale

A 
6 = obeys commands
5 = localizes pain
4 = flexion withdrawal
3 = decorticate rigidity (abnormal flexion)
2 = decerebrate rigidity (extension)
1 = no movement
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3
Q

Describe the verbal scoring for the Glasgow Coma Scale

A 
5 = oriented and converses
4 = disoriented and converses
3 = inappropriate words
2 = incomprehensible sounds
1 = no speech
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4
Q

What does the Hunt-Hess scale describe and what is it a predictor of?

A
  • Describes severity of SAH

- Predictor of prognosis/outcomes

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5
Q

Hunt-Hess Grade 1

A
  • Asymptomatic/minimal headache with neck stiffness

- 70% survival

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6
Q

Hunt-Hess Grade 2

A
  • Moderate/severe headache, neck stiffness
  • No neuro deficits except for cranial nerve palsy
  • 60% survival
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7
Q

Hunt-Hess Grade 3

A
  • Drowsy with neurologic deficit

- 50% survival

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8
Q

Hunt-Hess Grade 4

A
  • Stuporous, moderate/severe hemiparesis
  • Possible early decerebrate rigidity and vegetative disturbances
  • 20% survival
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9
Q

Hunt-Hess Grade 5

A
  • Deep coma, decerebrate, moribund

- 10% survival

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10
Q

What does the Fisher Scale describe and what is it a predictor for?

How is the modified Fisher scale different and why is it preferred?

A
  • Classifies SAH on CT scans according to amount of blood
  • Used to predict risk for vasospasm
  • Modified Fisher scale accounts for thick cisternal and intraventricular/intraparenchymal hemorrhage
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11
Q

Modified Fisher Scale Group 1

A

Focal or diffuse, thin SAH, no IVH

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12
Q

Modified Fisher Scale Group 2

A

Focal or diffuse, thin (

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13
Q

Modified Fisher Scale Group 3

A

Focal or diffuse, thick (>1mm) SAH, no IVH

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14
Q

Modified Fisher Scale Group 4

A

Focal or diffuse, thick (>1mm) SAH, with IVH

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15
Q

Modified Fisher Scale Group 0

A

No SAH or IVH

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16
Q

What does the World Federation of Neurosurgical Societies (WFNS) grading system describe and predict?

A

Severity of SAH based on GCS and neurological deficits; used to predict outcomes

17
Q

WFNS Grade 1

A

GCS 15

18
Q

WFNS Grade 2

A

GSC 13-14 without deficit

19
Q

WFNS Grade 3

A

GCS 13-14 with focal neurologic deficit

20
Q

WFNS Grade 4

A

GCS 7-12

21
Q

WFNS Grade 5

A

GCS

22
Q

What does the Spetzler-Martin grading scale describe and what does it correlate with?

A

A point system used to describes intracranial AVMs and correlating with operative outcomes

23
Q

In the Spetzler-Martin grading system how are points allocated for the size of the AVM nidus?

A

Small (6cm) = 3

24
Q

in the Spetzler-Martin grading system how are points allocated for eloquence of adjacent brain?

A 
Eloquent brain (or adjacent) = 1
Non-eloquent = 0
25
Q

In the Spetzler-Martin grading system how are points allocated for venous drainage?

A

Deep venous drainage = 1

Superficial venous drainage only = 0

26
Q

What is the American Spinal Injury Association (ASIA) impairment scale used for?

A

Grading the extent and severity of spinal injury

27
Q

ASIA A

A

Complete: complete lack of motor and sensory abilities below injured spinal level

28
Q

ASIA B

A

Incomplete: some sensory function is preserved below injured spinal level (including anal sensation) but no motor response below

29
Q

ASIA C

A

Incomplete: motor function is preserved below level of spinal injury but more than half of key muscles have strength

30
Q

ASIA D

A

Incomplete: motor function preserved below level of injury with more than half of key muscles having strength > 3

31
Q

ASIA E

A

Normal

32
Q

Describe the following for muscle strength grading:

0:
1:
2:
3:
4:
5:
A

0: Paralysis
1: Muscle twitch
2: Active movement with full ROM when gravity eliminated
3: Active movement with full ROM against gravity
4: Active movement with full ROM against gravity and providing some resistance
5: Full strength

33
Q

What is grading of diffuse axonal injury (DAI) is primarily based off and what does it correlate with?

A

Based off anatomic distribution and correlates with outcome

34
Q

Grade I DAI

A

Involves grey-white matter interface and more commonly in parasagittal frontal or periventricular temporal lobes (may not see on conventional imaging)

35
Q

Grade II DAI

A

Involves corpus callosum (commonly posterior body and splenium but advances anteriorly with injury severity) as well as grade I locations

36
Q

Grade III DAI

A

Involves brainstem in addition to Grade I and II locations (commonly rostral midbrain, superior cerebellat peduncles, medial lemnisci, and corticospinal tracts)

Neurosurgery (7 decks)

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