Grading Systems Flashcards
Describe the eye scoring for the Glasgow Coma Scale
4 = open spontaneously 3 = to verbal stimulation 2 = to pain 1 = don't open
Describe the motor scoring for the Glasgow Coma Scale
6 = obeys commands 5 = localizes pain 4 = flexion withdrawal 3 = decorticate rigidity (abnormal flexion) 2 = decerebrate rigidity (extension) 1 = no movement
Describe the verbal scoring for the Glasgow Coma Scale
5 = oriented and converses 4 = disoriented and converses 3 = inappropriate words 2 = incomprehensible sounds 1 = no speech
What does the Hunt-Hess scale describe and what is it a predictor of?
- Describes severity of SAH
- Predictor of prognosis/outcomes
Hunt-Hess Grade 1
- Asymptomatic/minimal headache with neck stiffness
- 70% survival
Hunt-Hess Grade 2
- Moderate/severe headache, neck stiffness
- No neuro deficits except for cranial nerve palsy
- 60% survival
Hunt-Hess Grade 3
- Drowsy with neurologic deficit
- 50% survival
Hunt-Hess Grade 4
- Stuporous, moderate/severe hemiparesis
- Possible early decerebrate rigidity and vegetative disturbances
- 20% survival
Hunt-Hess Grade 5
- Deep coma, decerebrate, moribund
- 10% survival
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?
- 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
Modified Fisher Scale Group 1
Focal or diffuse, thin SAH, no IVH
Modified Fisher Scale Group 2
Focal or diffuse, thin (
Modified Fisher Scale Group 3
Focal or diffuse, thick (>1mm) SAH, no IVH
Modified Fisher Scale Group 4
Focal or diffuse, thick (>1mm) SAH, with IVH
Modified Fisher Scale Group 0
No SAH or IVH
What does the World Federation of Neurosurgical Societies (WFNS) grading system describe and predict?
Severity of SAH based on GCS and neurological deficits; used to predict outcomes
WFNS Grade 1
GCS 15
WFNS Grade 2
GSC 13-14 without deficit
WFNS Grade 3
GCS 13-14 with focal neurologic deficit
WFNS Grade 4
GCS 7-12
WFNS Grade 5
GCS
What does the Spetzler-Martin grading scale describe and what does it correlate with?
A point system used to describes intracranial AVMs and correlating with operative outcomes
In the Spetzler-Martin grading system how are points allocated for the size of the AVM nidus?
Small (6cm) = 3
in the Spetzler-Martin grading system how are points allocated for eloquence of adjacent brain?
Eloquent brain (or adjacent) = 1 Non-eloquent = 0
In the Spetzler-Martin grading system how are points allocated for venous drainage?
Deep venous drainage = 1
Superficial venous drainage only = 0
What is the American Spinal Injury Association (ASIA) impairment scale used for?
Grading the extent and severity of spinal injury
ASIA A
Complete: complete lack of motor and sensory abilities below injured spinal level
ASIA B
Incomplete: some sensory function is preserved below injured spinal level (including anal sensation) but no motor response below
ASIA C
Incomplete: motor function is preserved below level of spinal injury but more than half of key muscles have strength
ASIA D
Incomplete: motor function preserved below level of injury with more than half of key muscles having strength > 3
ASIA E
Normal
Describe the following for muscle strength grading:
0: 1: 2: 3: 4: 5:
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
What is grading of diffuse axonal injury (DAI) is primarily based off and what does it correlate with?
Based off anatomic distribution and correlates with outcome
Grade I DAI
Involves grey-white matter interface and more commonly in parasagittal frontal or periventricular temporal lobes (may not see on conventional imaging)
Grade II DAI
Involves corpus callosum (commonly posterior body and splenium but advances anteriorly with injury severity) as well as grade I locations
Grade III DAI
Involves brainstem in addition to Grade I and II locations (commonly rostral midbrain, superior cerebellat peduncles, medial lemnisci, and corticospinal tracts)
