Neuro Exams
                                ===========

þ Canadian Neurological Scale

REFERENCE:

        Cote-R; Bautista-RN; Wolfson-C; Boucher-J; Adams-J; Hachinski-V; The
        Canadian Neurological Scale: validation and reliability assessment.
        Neurol.  1989; 39: 638-643

        Cote et al. published the first version in the Stroke J. 1986,
        which was later modified in the 1989 version.
        Here is the CNS tool:

NEUROLOGIC DEFICIT EVALUATIONS - THE CANADIAN NEUROLOGIC SCALE

Instructions:
1.      Alert or drowsy stroke patients should be evaluated with the CNS
2.      Type the Date/Time of the evaluation
3.      The CNS is a standardized neurologic deficit scale with a range
        between 1.5 to 11.5.  The normal is 11.5 and severe strokes have
        a CNS score closer to 1.5.
4.      Circle the appropriate responses in [ ] and then add the circled
        values to get a total.
5.      The numeric values are 0, 0.5, 1 or 1.5 and 3.
6.      The scored values are enclosed in brackets [ ]
7.      The Glasgow Coma Scale (GCS) is used in about 5% of stroke
        patients an it is not included here.

Start of CNS:

Date: -----------       Time: ------------

Level of
Consciousness (LOC)     Alert   Drowsy  Stuporous>      Comatous>
                        [3]     [1.5]   GCS             GCS

Oriented                Yes     No      NA
                        [1]     [0]     [0]

Speech Deficit          None    Expressive      Receptive (jump)-->>>
                        [1]     [.5]            [0]

Face weakness            None   Present
                        [.5]    [0]

Arm Weakness
        Proximal        None    Mild    Significant     Total
                        [1.5]   [1]     [.5]            [0]

        Distal          None    Mild    Significant     Total
                        [1.5]   [1]     [.5]            [0]

Leg Weakness
        Proximal        None    Mild    Significant     Total
                        [1.5]   [1]     [.5]            [0]

        Distal  None    Mild    Significant     Total
                        [1.5]   [1]     [.5]            [0]



Motor Weakness - Receptive <<<---------- (Jump here)
Instructions:
1.      This latter part of the test is reserved for patients that have
receptive aphasia.  They do not understand (get) commands.  So you have
to open the eyes with your fingers or pull the face to see which side is
weak.  For extremities, you lift them and the one that falls first is the
weak one.

        Face            Symmetrical     Asymmetrical
                        [.5]            [0]

        Arms            Equal           Unequal
                        [1.5]           [0]

        Legs            Equal           Unequal
                        [1.5]           [0]


Notice that MOTOR WEAKNESS and MOTOR RESPONSE are exclusive.
The CNS score is  the added value  _____/11.5 (over the maximum total)
or the score/max total score.

The final score is reported as 5.5/11.5 with Right or Left sided
weakness and with or without aphasia.

RESULTING SEVERITIES:
Mild strokes are within the range of 8.5-11.5/11.5
Moderate strokes are within the range of 5.0-8.0/11.5
Severe strokes are within the range of 1.5-4.5/11.5
Extremely severe strokes (patients in stupor) require GCS evaluation
Massive strokes (patients in coma) require GCS evaluation

---------------------------------------------------------
End of CNS
From:             Lombardo F Palma <Lombardo.Palma@m.cc.utah.edu>


----------------
Greg Henry:
Rapid Neuro exam:
if can talk, CN XII intact.
Motor exam:  only really need to do Romberg and look for pronator drift:
  parietal lobe disease may also cause "wandering hand."