Vascular

**Barthel Index**
Activity performance score in stroke victims
Activity	Scores (0, 5, 10, 15)
Feeding	0 = Unable	5 = Needs help cutting, spreading butter, etc., or required modified diet		-	-
Bathing	0 = Dependent	5 = Independent (or in shower)		-	-
Grooming	0 = Needs help with personal care	5 = Independent face/hair/teeth/shaving (implements provided)		-	-
Dressing	0 = Dependent	5 = Needs help but can do about half unaided	10 = Independent (including buttons, zips, laces, etc.)	-
Bowels	0 = Incontinent (or needs enemas)	5 = Occasional accident	10 = Continent	-
Bladder	0 = Incontinent, or catheterized and unable to manage alone	5 = Occasional accident	10 = Continent	-
Toilet Use	0 = Dependent	5 = Needs some help, but can do something alone	10 = Independent (on and off, dressing, wiping)	-
Stairs	0 = Unable	5 = Needs help (verbal, physical, carrying aid)	10 = Independent	-
Transfers (bed to chair and back)	0 = Unable, no sitting balance	5 = Major help (one or two people, physical), can sit	10 = Minor help (verbal or physical)	15 = Independent
Mobility (on level surface)	0 = Immobile or <50 yards	5 = Wheelchair independent, including corners, >50 yards	10 = Walks with help of one person (verbal or physical) >50 yards	15 = Independent (but may use any aid) >50 yards

**Fischer Scale**
Classify severity of SAH on CT scan, predictive for vasospasm
Group 1	No blood detected
Group 2	Diffuse or vertical layers <1mm thick without clots
Group 3	Localized clots and/or vertical layers >1mm thick
Group 4	Intracerebral or intraventricular clot (with or without SAH)

**Modified Fischer Scale**
Modified classification for severity of SAH on CT scan, predictive for vasospasm
Group 1	Focal or diffuse thin SAH, no IVH
Group 2	Focal or diffuse thin SAH, with IVH
Group 3	Thick SAH, no IVH
Group 4	Thick SAH, with IVH

**Hunt & Hess Grading Scale**
Classify severity of SAH, predictive for survival
Grade 1	Asymptomatic, minimal headache, slight nuchal rigidity
Grade 2	Moderate to severe headache, nuchal rigidity, no neurologic deficit except cranial nerve palsy
Grade 3	Drowsiness, minimal neurologic deficit
Grade 4	Stupor, moderate-severe hemiparesis, possible early decerebrate rigidity, vegetative disturbances
Grade 5	Coma, decerebrate rigidity

**Intracerebral Hemorrhage Score**
30-day mortality predictor for ICH
	0	+1	+2
GCS	13-15	5-12	3-4
Age	<80 years	>=80 years	-
ICH Volume	<30cm³	>=30cm³	-
Intraventricular hemorrhage	No	Yes	-
Infratentorial origin of ICH	No	Yes	-
ICH Score 0 = no mortality ICH Score 1 = 13% ICH Score 2 = 26% ICH Score 3 = 72% ICH Score 4 = 97% ICH Score 5 = 100% ICH Score 6 = 100%

**Intraventricular Hemorrhage Score**
Estimate of IVH volume, predictor of mortality
	0	1	2	3
Right & Left Lateral Ventricle	No blood	<1/3 full	1/3 to 2/3 full	>2/3 full
3rd & 4th Ventricle	No blood	Any blood	-	-
Hydrocephalus	No	Yes	-	-
Calculation	IVH score = 3 x (RLV + LLV + Hydrocephalus) + III + IV

**Modified Rankin Scale**
Scale for assessment of functional status after stroke
Score	Description
0	No symptoms
1	No significant disability – has symptoms, able to carry out usual activities
2	Slight disability – unable to carry out all previous activities
3	Moderate disability – requires help, able to walk without assistance
4	Moderately severe disability – unable to walk or attend to bodies needs without assistance
5	Severe disability – bedridden, incontinent, needs constant nursing care
6	Dead

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**National Institutes of Health Stroke Scale**
Quantification of stroke severity
1. Level of Consciousness
1A (LOC)
0 = Alert, keenly responsive	1 = Not alert, arouses to minor stimulation	2 = Not alert, requires repeated stimulation to arouse	3 = Response with only reflexes or totally unresponsive	-
1B (LOC Questions - request current month and age)
0 = Answers both questions right	1 = Answers one question correct, or dysarthric/intubated	2 = Answers neither question correctly, or aphasic	-	-
1C (LOC Commands - blink eyes & squeeze hands)
0 = Performs both tasks correctly	1 = Performs one task correctly	2 = Performs neither task correctly	-	-
2. Best Gaze (Test horizontal eye movements)
0 = Normal	1 = Partial gaze palsy	2 = Forced deviation	-	-
3. Visual (Visual fields tested by confrontation)
0 = No visual loss	1 = Partial hemianopia	2 = Complete hemianopia	3 = Bilateral hemianopia (including cortical blindness)	-
4. Facial Palsy (Show teeth, raise eyebrows, close eyes)
0 = Normal	1 = Minor paralysis (flattened nasolabial folds, asymmetry on smile)	2 = Some effort against gravity, cannot maintain 90^o (or 45^o), drifts down to bed
5. Motor Arm (Extend the arms (palms down) 90^o (if sitting) or 45^o (if supine)) 5A = Left Arm; 5B = Right Arm UN = Amputation or joint fusion, explain why untestable
0 = No drift, held for full 10 seconds	1 = Drift down before 10 seconds, but not hitting bed or support	2 = Some effort against gravity, cannot maintain 90^o (or 45^o), drifts down to bed	3 = No effort against gravity, limb falls	4 = No movement
6. Motor Leg (Hold leg at 30 ^o while supine) 6A = Left Leg; 6B = Left Leg UN = Amputation or joint fusion, explain why untestable
0 = No drift, held for full 5 seconds	1 = Drift down before 5 seconds, but not hitting bed	2 = Some effort against gravity, but leg falls to bed by 5 seconds	3 = No effort against gravity, leg falls	4 = No movement
7. Limb Ataxia (Bilateral finger-nose-finger, heel-shin tests) UN = Amputation or joint fusion, explain why untestable
0 = Absent	1 = Present in one limb	2 = Present in two limbs	-	-
8. Sensory (Sensation or grimace to pinprick when tested or withdraw from noxious stimuli in obtunded or aphasic patient)
0 = Normal, no sensory loss	1 = Mild-to-moderate sensory loss, less sharp or is dull in affected side, or loss of superficial pain but aware of touch)	2 = Severe or total sensory loss, not aware of being touched in face, arm, and leg	-	-
9. Best Language
0 = No aphasia, normal	1 = Mild-to-moderate aphasia, obvious loss of fluency or comprehension, without limitation on ideas expressed or form of expression. Reduced speech and/or comprehension however makes conversation about materials difficult	2 = Severe aphasia, all communication is fragmentary expression, great need for inference, questioning, and guessing by listener. Examiner carries conversation.	3 = Mute, global aphasia, no usable speech or auditory comprehension	-
10. Dysarthria UN = Intubated or physical barrier
0 = Normal	1 = Mild-to-moderate dysarthria, slurs at least some words but at worst continues to be understood	2 = Severe dysarthria, such slurring of speech that it is unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric	-	-
11. Extinction and Inattention
0 = No abnormality	1 = Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities	2 = Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space	-	-

**Pollock-Flickinger Score**
AVM grading scale to predict patient outcomes from radiosurgery
AVM Score	<=1.00	1.01 – 1.50	1.51 – 2.00	>2.00
Chance (%) of excellent outcome (95% CI)	89 (79-94)	70 (59-79)	64 (51-75)	46 (33-60)
Chance (%) of modified Rankin Scale decline (95% CI)	0 (0-8)	13 (7-22)	20 (12-32)	36 (24-50)
AVM Score = (0.1)(volume, cc) + (0.02)(age, years) + (0.5)(location, see below) Frontal, temporal, parietal, occipital, intraventricular, corpus callosum, cerebellar = 0 Basal ganglia, thalamus, brainstem = 1

**Spetzler-Martin Arteriovenous Malformation Grading System**
AVM grading scale predictive of operative outcome (Grades 1 – 6)
	0	1	2	3
Size of Nidus	-	Small (<3cm)	Medium (3-6cm)	Large (>6cm)
Eloquence of Adjacent Brain	Non-eloquent	Eloquent	-	-
	Eloquent = sensorimotor, language, visual cortex, hypothalamus, thalamus, brain stem, cerebellar nuclei, or adjacent regions Non-eloquent = frontal lobe, temporal lobe, cerebellar hemispheres
Venous Drainage	Superficial only	Deep	-	-
Summation of scores (range 1-5) = Grade (falls into 1 of 6 grades) Note: Grade 6 = inoperable

**Spetzler-Ponce Classification**
AVM classification tier guiding treatment and predictive of outcome
Class	Spetzler-Martin Grade	Management	Negative outcome rate (%) (95% CI)
A	1, 2	Microsurgical resection	8 (6-10)
B	3	Multimodality treatment	18 (15-22)
C	4, 5	No treatment except recurrent hemorrhages, progressive neurologic deficits, steal-related symptoms, and AVM-related aneurysms	32 (27-38)

**Stroke Management Timeline**
Time (Hours from symptom onset)	IV tPA	IA tPA (Consider after IV tPA failure)	Mechanical Embolectomy (Consider after IV tPA failure)
1	✓	✓	✓
2	✓	✓	✓
3	✓	✓	✓
4	✓	✓	✓
5	Up to 4.5hr	✓	✓
6	-	✓	✓	Verify perfusion prior to procedure
7	-	-	✓
8	-	-	✓
>9	-	-	-