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Vascular

Last Updated: October 1, 2018

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
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 90o (or 45o), drifts down to bed

5. Motor Arm (Extend the arms (palms down) 90o (if sitting) or 45o (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 90o (or 45o), 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 - - -
WFNS Subarachnoid Hemorrhage Grading Scale
Classification scale for severity of SAH predictive of outcomes
Grade GCS Focal Motor Deficit
1 15 -
2 14 – 13 -
3 14 – 13 +
4 12 – 7 +/-
5 6 – 3 +/-

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