Annex G4. NIHSS scale (National Institutes of Health Stroke Scale) - National Institutes of Health Stroke Scale

National Institutes of Health Stroke Scale / NIH Stroke Scale

Developed by the American National Institutes of Health (National Institutes of Health Stroke Scale - NIH Stroke Scale) T. Brott et al, 1989, J. Biller et al, 1990.

It is used to objectify the state of a patient with ischemic stroke at admission, in the dynamics of the process and the outcome of a stroke by the 21st day of hospitalization.

The scale contains 15 points that characterize the main functions that are most often impaired due to cerebral stroke. Functions are evaluated in points. The scale is notable for its obvious simplicity, filling it requires no more than 5-10 minutes, disciplines the doctor in terms of the need for a comprehensive study of the neurological status, and allows you to record the dynamics of the patient's condition in the acute period of the disease. The internal consistency and retest reliability of the scale has been confirmed by a number of studies (Goldstein J.C. et al 1989). neurological status is provided as 0 points, the death of the patient - 31 points.

Every neurologist is familiar with the National Institutes of Health Stroke Scale (NIHSS). After all, it is her data that is used to decide on the advisability of thrombolytic therapy, evaluate its effectiveness, and also to determine the prognosis of the disease. The principle is this: the more points on the NIHSS scale, the more severe the condition.

In the case of a neurological deficit of more than 3 points on the NIHSS scale, this is regarded as an indication for thrombolytic therapy. If the patient's condition corresponds to more than 25 points on this scale, this is a relative contraindication to thrombolysis. There is evidence that with a score of less than 10 points, the probability of a favorable outcome after 1 year = 60-70%, and with a score of more than 20 points = 4-16%.

Evgeny Chernyshkov contributed to the popular scale appearing in smartphones medical workers. So, back in 2012, there was NIHSS application for Android devices that works well on both smartphones and tablets.

Compatible with Android devices only.

Language: Russian, English.

National Institutes of Health Stroke Scale (NIHSS)

1. Level of consciousness:

• 0 - conscious, actively reacting;
• 1 - doubt, but wake up with minimal irritation, follow commands, answer questions;
• 2 - stupor, requires repeated stimulation to maintain activity or lethargy, and requires strong and painful stimulation to produce non-stereotypical movements;
• 3 - coma, reacts only with reflex actions or completely does not respond to stimuli

2. Level of consciousness - questions:

Ask the patient what month it is and his age. Write down the first answer.

If aphasia and stupor - score 2.

If endotracheal tube, trauma, severe dysarthria, language barrier score 1.

• 0 - the correct answer to both questions;
• 1 - the correct answer to one question;
• 2 - none of the questions were answered correctly

3. Level of consciousness - execution of commands:

The patient is asked to open and close their eyes, then to squeeze and unclench their non-paralyzed hand. Only the first attempt counts:

• 0 - both commands are executed correctly;
• 1 — one command was executed correctly;
• 2 - no command executed correctly

4. Movement of the eyeballs:

Only horizontal eye movements are taken into account:

• 0 - norm;
• 1 - partial paralysis of the gaze;
• 2 - tonic abduction of the eyes or complete paralysis of the gaze, not overcome by the induction of oculocephalic reflexes

5. Examination of visual fields:

• 0 - norm;
• 1 - partial hemianopsia;
• 2- complete hemianopsia

6. Paresis of the facial muscles:

• 0 - norm;
• 1 - minimal paralysis (asymmetry);
• 2 - partial paralysis - complete or almost complete paralysis of the lower muscle group;
• 3 - complete paralysis (lack of movement in the upper and lower muscle groups)

7. Movements in the upper limbs:

The arms are raised for 10 seconds at an angle of 45 degrees if the patient is lying down, and 90 degrees if the patient is sitting. If the patient does not understand, then the doctor must place the hands in position himself. Scores are recorded separately for the right and left limbs:

On right:
• 4 - no active movements;

Left:
• 0 - no lowering for 10 seconds;
• 1 - lowers after a short hold (before 10 seconds);
• 2 - limbs cannot rise or maintain an elevated position, but produce some resistance to gravity;
• 3 - limbs fall without resistance to gravity;
• 4 - no active movements;
• 9 - impossible to check (limb mutated, artificial joint)

8. Movements in lower limbs:

If the patient is lying, raise the paretic leg for 5 seconds at an angle of 30º.

Scores are recorded separately for the right and left limbs.

On right:
• 3 - limbs fall without resistance to gravity;
• 4 - no active movements;
• 9 - impossible to check (limb amputated, artificial joint)

Left:
• 0 - no lowering for 5 seconds;
• 1 - lowers after a short hold (before 5 seconds);
• 2 - the limbs cannot rise or maintain an elevated position, but offer some resistance to gravity;
• 3 - limbs fall without resistance to gravity;
• 4 - no active movements;
• 9 - impossible to check (limb amputated, artificial joint)

9. Ataxia of limbs:

Finger-nose and heel-to-knee tests are carried out on both sides. Ataxia is counted if it is not due to weakness:

• 0 - absent;
• 1 - in one limb;
• 2 - in two limbs

10. Sensitivity:

Only hemitetype disorder is taken into account:

• 0 - norm;
• 1 - mild or moderate violations;
• 2 - significant or complete violation of sensitivity.

11. Aphasia:

Ask the patient to describe the picture, name the object, read the sentence:

• 0 - no aphasia;
• 1 - mild aphasia;
• 2 - severe aphasia;
• 3 - complete aphasia

12. Dysarthria:

• 0 - normal articulation;
• 1 - soft or medium. May not pronounce some words;
• 2 - severe dysarthria
• 9 - intubated or other physical barrier

13. Agnosia (ignorance):

• 0 - no agnosia;
• 1 - ignoring to bilateral sequential stimulation of one sensory modality;
• 2 - severe hemiagnosia or hemiagnosia in more than one modality.

Total score:

Interview with Nathan Bornstein

Interview with Nathan Bornstein

Nathan M. Bornstein (IL), MD

Neurological Department, Medical Center. Sorasky, Tel Aviv

Nathan M. Bornstein is Professor and Head of the Department of Neurology at Medical center them. Elias Sorasky, Faculty of Medicine. Sackler, Tel Aviv University, Israel.

Dr. Bornstein's scientific interests are in the following areas: lateralized epileptiform discharges (PLEDs) that developed after a stroke and are associated with metabolic disorders, non-valvular atrial fibrillation, menopause and ischemic stroke, the role of hormone replacement therapy, antiplatelet agents in the treatment of strokes, infection as a trigger for ischemic stroke, transcranial Doppler sonography, dynamics and treatment of asymptomatic carotid stenosis and clinical significance of hemorrhages in carotid plaques.

Dr. Bornstein is a lead researcher for the Tel Aviv Stroke Registry and the Mediterranean Stroke Society, and a member of the European Stroke Registry. Author and co-author of more than 90 scientific articles on cerebrovascular diseases published in such journals as Stroke, Neurology, Adverse Neurology, Cardiology, Acta Diabetologiсa, Cerebrovascular Diseases, Lancet, Archives of Neurology, Headache, The Journal of Neurological Sciences, The European Journal of Neurology.

— Professor Bornstein, you recently visited Seoul and took part in the work of the International Stroke Congress. What are the most significant scientific and clinical studies you would highlight?

— This year was not marked by such cutting-edge research as ECASS III in 2008 conducted in Vienna. However, the congress presented the results of several important studies, namely the SENTIS study on the use of the NeuroFlo catheter to enhance cerebral circulation in acute ischemic stroke, and CASTA regarding the use of Cerebrolysin in the treatment of acute ischemic stroke. Dr. Cohen and Dr. Dirnagl's brilliantly delivered lectures on the impressive results of preclinical scientific studies in stroke models also attracted attention.

- Professor Bornstein, you personally participated in the CASTA study. How would you comment on the main results of the study?

- Yes, that's right. I served on the Steering Committee and therefore have some responsibility for the design of this study. More than 1060 patients were included, of which more than 900 completed the study. The final results of the study regarding primary performance indicators were neutral. However, we think that this was probably due to the fact that a large proportion of the study patients experienced mild strokes, with a median NIHSS stroke score of 9, as too many mild cases were included in the study. , then the “ceiling effect” could be strongly manifested.

— Professor Geiss, an ardent supporter of evidence-based medicine, presented the results of the CASTA study from an optimistic and positive perspective. What are these conclusions about?

— I think that at the time of presentation of the data, the possible existence of a “ceiling effect” was correctly pointed out, which may explain the neutral results of the study. However, Cerebrolysin showed significant beneficial effects in a subset of patients with baseline NIHSS > 12 or even higher (NIHSS > 17). These effects should be taken into account by clinicians as this is the first case among clinical research strokes, when the neuroprotective agent demonstrates such a pronounced clinical efficacy.

Could you tell us a little more about these beneficial effects?

— In a subgroup of 246 people enrolled in the CASTA study with NIHSS scores > 12, the study drug group experienced an improvement of approximately 5 points on the NIHSS after 90 days, compared with the control group, where the decrease was less than 2 points . This difference of 3 points indicates the development of a very pronounced clinical improvement in the treatment of patients with Cerebrolysin. It is also important to note that positive effects were observed already on the 10th day of treatment - the point in time when clinicians can decide to intensify neurorehabilitation if the patient's biological state is stable. For many patients, this decline means that if they start rehabilitation early, instead of a long-term course of the disease, their condition will improve continuously.

- Were the results obtained in patients with strokes in the right or left hemispheres different?

- As far as I know, no. This indicates that improvement occurs in any case, regardless of the side of the damage. However, we must wait for the final report of the results of the study, which will appear sometime at the end of December, in order to more accurately answer the question of which subgroups of patients benefited most from Cerebrolysin therapy.

- Please explain if any positive effect can be expected in patients with mild stroke, since CASTA does not give a clear answer to this question.

- A positive effect can also be determined in patients suffering from mild forms of stroke and having, accordingly, low values ​​on the NIHSS scale. However, many more patients must be included in the study for this to happen. Imagine, for example, two patients with mild stroke, one in the placebo group and one in the Cerebrolysin group, with an NIHSS score of 8. As you well know, mild stroke usually improves within 90 days to the point where neurological disorders become very small and patients' cognitive/motor functions can be restored. As a result, it is difficult to identify significant healing effect in this group

Previous studies have shown that Cerebrolysin helps such patients recover faster, which improves the quality of life of patients and their caregivers. We can also assume that patients who recover faster do not develop post-stroke depression, which often occurs with a long course of disorders.

“Another important aspect of stroke research is data on the safety of treatment. What were they like in the CASTA study?

“One of the most important benefits of Cerebrolysin has always been the safe profile of its use, and this was again confirmed in the CASTA study, for the first time in more than 1000 patients. In particular, there was a trend towards a decrease in mortality in the Cerebrolysin group by 1.3%. I think that this figure will be even higher in the subgroup of patients with more severe lesions in the final report. But for now, all of this is just speculation.

- Do you believe that, in the end, convincing data can be obtained on the possibility of a significant neuroprotective effect in ischemic stroke?

- Yes, I believe. However, we must understand that for many years, neuroscientists around the world have had high hopes that neuroprotective effects could achieve the status of a proven therapy when acute stroke in addition to r-tPA. But, the results of several studies fell short of these expectations.

What kind of research do you mean?

“Recent studies include the SAINT study on NXY-059 and the EAST study on a free radical scavenger called Edaravone. In both cases, negative results were obtained. We can also recall the great review by James Grotta in 2004, which looked at drugs tested as neuroprotective agents, with negative results in almost all cases.

Do you believe in the future of Cerebrolysin?

“From my point of view, more research needs to be done on the use of Cerebrolysin in acute ischemic stroke. However, the pronounced positive trends in the subgroups of the CASTA study should impress both the pharmaceutical company and the medical community. As is known, for only a small number of drugs, certainty in relation to evidence has been achieved in one step. However, the first step is always the hardest, and the first step taken in this Cerebrolysin study was very impressive for both the pharmaceutical company and us stroke specialists.

— Cerebrolysin is a biological drug with a complex multimodal action. Don't you think that this complexity is part of the answer to why Cerebrolysin is a good candidate for hard evidence?

You raised a very interesting question. In parallel with clinical research, we must also study the mechanisms of action of Cerebrolysin in acute stroke. Preclinical data indicate that Cerebrolysin is a multimodal drug that is useful for both neuroprotection in acute stroke and long-term neurorehabilitation. In addition, due to its ability to influence the ischemic cascade on various levels(pleiotropic effect) it is the most suitable candidate for neuroprotection in the acute period of stroke.

If you remember Stephen Davis' lecture at the International Stroke Congress in Seoul, he noted that there is already proof of concept related to Cerebrolysin, the only thing missing is randomized controlled trials (RCTs). We already know that the mechanism of action of Cerebrolysin is pleiotropic and multimodal. In this regard, it is appropriate to recall that back in 2006, Marc Fisher expressed the opinion that the best candidates for identifying efficacy in large RCTs are agents with multimodal effects, including neurotrophic factors.

Cerebrolysin may even be a better candidate than neurotrophic factors alone due to its more pronounced multimodal properties. This is due to the fact that it mimics the influence of neurotrophic factors, and the active peptides contained in the preparation are small enough to pass through the blood-brain barrier, which enhances the effect.

- Well, let's finish this interview, look into the future. What do you think will happen next in Cerebrolysin research?

— Over the past few weeks, I have been discussing with my colleagues the CASTA study and its results. The signal I received is clear enough that everyone hopes that the sponsor will soon initiate a new study, the design of which will be adjusted to focus only on patients with moderate to severe strokes, which may require higher doses. drug or increase the duration of treatment.

We must extract important lessons from the CASTA study. And if the subgroup analysis proves to be justified, then the next study is likely to find positive significant results, which will be an excellent achievement in the treatment of strokes.

— Professor Bornstein, we would like to thank you for sharing with us information about this important congress held in Seoul, and in particular about the CASTA study.

Thank you for your questions. Was happy to help.

"SCALES FOR ASSESSING THE SEVERITY OF ISCHEMIC STROKE IN THE ACUTE PERIOD NIHSS Scale Severity neurological symptoms in the acute period of ischemic stroke ... "

SCALE IN GENERAL

NEUROLOGY

SCALES FOR ASSESSING THE DEGREE OF SEVERITY

ISCHEMIC STROKE IN THE ACUTE PERIOD

NIHSS scale

The severity of neurological symptoms in the acute period

ischemic stroke, it is advisable to evaluate in dynamics using specially designed scales. Widespread

of Health Stroke Scale). The NIHSS score is also important for planning thrombolytic therapy (TLT) and monitoring its effectiveness. The indication for thrombolytic therapy is the presence of a neurological deficit (from 3 points on the NIHSS scale), suggesting the development of disability. Severe neurological deficit (more than 25 points on this scale) is a relative contraindication to thrombolysis and does not significantly affect the outcome of the disease.

National Institutes of Health Stroke Severity Scale (NIHSS)

1. Level of consciousness (assessed in points):

0 - conscious, actively reacting;

1 - doubt, but can be awakened with minimal irritation, executes commands, answers questions;

2 - sopor - repeated stimulation is required to maintain activity, or inhibited - strong and painful stimulation is required to produce non-stereotypical movements;

3 - coma, reacts only with reflex actions or does not respond to stimuli.

2. Level of consciousness - answers to questions.

Ask the patient what month it is and his age. Write down the first answer. If aphasia or stupor - score 2.

If endotracheal tube, severe dysarthria, language barrier - 1.

0 - the correct answer to both questions;

1 - the correct answer to one question;

2 - no correct answers given.

3. Level of consciousness - execution of commands.

The patient is asked to open and close his eyes, to squeeze and unclench his non-paralyzed hand. Only the first attempt counts.

0 - both commands are executed correctly;

1 - one command is executed correctly;

2 - none of the commands were executed correctly.

4. Movement of the eyeballs.

Only horizontal eye movements are taken into account.

1 - partial gaze paralysis;

2 - tonic abduction of the eyes or complete gaze paralysis, not overcome by the induction of oculocephalic reflexes.

5. Examination of visual fields:

1 - partial hemianopia;

2 - complete hemianopsia.

6. Paresis of the facial muscles:

1 - minimal paralysis (asymmetry);

2 - partial paralysis - complete or almost complete paralysis of the lower muscle group;

3 - complete paralysis (lack of movement in the upper and lower muscle groups).

7. Movements in the upper limbs.

The arms are raised at a 45° angle in the supine position, at an angle of 90° in the sitting position. If the patient does not understand the task, the doctor must place his hands in the required position himself. Scores are recorded separately for the right and left limbs.

0 - limbs are held for 10 s;

1 - limbs are held for less than 10 s;

13 2 - limbs do not rise or do not maintain a given position, but produce some resistance to gravity;

4 - no active movements;

8. Movements in the lower extremities.

In the prone position, raise the paretic limb for 5 seconds at an angle of 30°. Scores are recorded separately for the right and left limbs.

0 - limbs are held for 5 s;

1 - limbs are held for less than 5 s;

2 - limbs do not rise or do not maintain an elevated position, but produce some resistance to gravity;

3 - limbs fall without resistance to gravity;

4 - no active movements;

5 - impossible to check (limb amputated, artificial joint).

9. Ataxia of the limbs.

Finger-nose and heel-to-knee tests are performed on both sides, ataxia is counted if it is not caused by paresis.

0 - absent;

1 - in one limb;

2 - in two limbs.

10. Sensitivity.

Only hemitetype disorder is taken into account.

1 - mild or moderate violations;

2 - significant or complete violation of sensitivity.

11. Aphasia.

The patient is asked to describe the picture, name the object, read the sentence.

0 - no aphasia;

1 - mild aphasia;

2 - severe aphasia;

3 - complete aphasia.

12. Dysarthria:

0 - normal articulation;

15 1 - mild or moderate dysarthria. Does not pronounce some words;

2 - severe dysarthria;

3 - intubated or other physical barrier.

13. Agnosia (ignorance):

0 - no agnosia;

1 - ignoring to bilateral sequential stimulation of one sensory modality;

2 - severe hemiagnosia or hemiagnosia in more than one modality.

The data obtained correspond to the following severity of neurological deficit:

0 - satisfactory condition;

3–8 - mild neurological disorders;

9–12 - moderate neurological disorders;

13–15 - severe neurological disorders;

16–34 - neurological disorders of extreme severity;

The use of the NIHSS scale will allow an objective approach to the condition of a patient with a stroke and assess the neurological status during the patient's stay in the hospital. The total score determines the severity and prognosis of the disease. With a score of less than 10 points, the probability of a favorable outcome after 1 year is 60-70%, and with a score of more than 20 points - 4-16%. This assessment is also important for planning thrombolytic therapy and monitoring its effectiveness. Thus, an indication for thrombolytic therapy is the presence of a neurological deficit (no more than 3–5 points). Severe neurological deficit (more than 25 points on this scale) is a contraindication to thrombolysis, since this manipulation may not have a significant impact on the outcome of the disease.

Systemic thrombolytic therapy is currently used in many cities of Ukraine. The NIHSS scale introduced into practical neurology has shown its effectiveness.

On the first day in patients after thrombolytic therapy, changes in the dynamics of the neurological status are assessed according to the NIHSS scale.

Clinical example. Patient K., aged 50, was admitted to neurological department Center for Thrombolytic Therapy GB No. 5

Mariupol with complaints of weakness and numbness of the left limbs.

When examining the neurological status - left-sided prosoparesis, pronounced left-sided hemiparesis, left-sided hemihypesthesia (according to the NIHSS scale - 10 points). Conducted CT, ECG, duplex scanning main vessels, express blood and urine tests.

Thrombolytic therapy started:

Bolus administration - the patient retains moderate left-sided prosoparesis, left-sided hemiparesis: expressed in the arm, moderately expressed in the leg; left-sided hemihypesthesia (NIHSS - 6 points);

At the end of TLT, the patient retains mild left-sided prosoparesis, left-sided moderate hemiparesis, left-sided hemihypesthesia (NIHSS - 4 points);

After 24 hours, the patient retains mild left-sided prosoparesis and mild paresis of the left hand (NIHSS - 2 points).

Scandinavian Stroke Scale For a combined assessment of the severity of patients in the acute period of ischemic stroke and the effectiveness of the treatment, the European Stroke Initiative also recommends using the Scandinavian Stroke Scale, according to which a significant improvement is noted if regression of neurological symptoms is observed on this scale (scores of 10 or more) and at the same time, there is a positive dynamics of laboratory and functional research methods. A moderate improvement can be judged if the regression of the neurological deficit is less than 10 points. At the same time, it is possible to improve some indicators of paraclinical research methods. A slight improvement - with minimal regression of neurological symptoms (1-2 points) and the absence of positive dynamics of laboratory and functional research methods.

19 Table 1. Scandinavian Stroke Study Group (SSS; Scandinavian Stroke Study Group, 1985)

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How to understand how badly a person suffered from a stroke? One hand does not move - is it strong or not very? And if the ability to live in our reality is lost?

There is no need to guess: there are special scales that allow you to assess how badly the brain is affected. Using them in the initial stages, doctors get a fairly accurate prognosis of a stroke. Further, according to these scales, it is assessed whether there are any changes in the patient's condition.

NIHHS scale

This is a scale that is applied from the first minutes of the disease. They work with her immediately after the diagnosis is established, by the number of points they decide already in the first hour whether thrombolysis can be performed or it will be dangerous. The NIHHS scale from the US National Institutes of Health is the most common method for assessing the severity of a person's condition after a stroke.

The test takes 10-15 minutes. It is important to evaluate all items in order, without first instructing the patient. The point is awarded for the person's actual reactions, not possible ones. As a result, the points are summed up.

Interpretation

If the assessment is carried out in the acute period, when the issue of thrombolysis (drug dissolution of the thrombus that caused the stroke) is being decided, then the assessment is as follows:

• 5-24 points - the procedure can be performed;
• 0-4 points - thrombolysis will not be able to affect the prognosis and development of disability.

If you need to estimate the chance of a full recovery in a year, then look like this:

• less than 10 points - a chance of 60-70%;
• more than 20 points - a chance of 4-16%.

Scandinavian scale

It assesses the severity of ischemic stroke in its acute period (that is, from the moment of occurrence to 7 days) and then in dynamics:

Interpretation

If the difference between the original and second score is 10 points or more, it is considered a significant improvement. Moderate positive dynamics - if 3-10 points. Slight improvement - a difference of 1-2 points.

Simultaneously with the Scandinavian scale, laboratory results and functional research methods are evaluated.

Rankin scale

It is used to understand the long-term perspective: what kind of care the patient will need.

Interpretation

• Grade 0: No household help required.
• 1 degree: need help 1 time per month.
• Grade 2: Without help, he can do no more than 1 week.
• Grade 3: Need help several times a week. Plus, the person needs psychological help.
• Grade 4: help is needed daily, but you can leave a person alone - for a short period of time.
• Grade 5: care is needed constantly.

Rivermead scale

It measures a person's ability to move after a stroke. It does not mean movement with the help of improvised means or a wheelchair.

The calculation is as follows: for each answer "Yes" - 1 point. The scores are then added up.

Interpretation

• 0-1 points: Need a 24-hour caregiver or continued stay in the hospital;
• 2-3 points: rehabilitation measures are needed in a hospital at a polyclinic;
• 4-7 points: recovery is carried out either without hospitalization, or with a short stay in a hospital with continued rehabilitation in a polyclinic;
• 8 or more points: polyclinic rehabilitation is enough.

You can independently evaluate the condition of your relative who suffered from a stroke using these scales. This will help you draw your own conclusions about his condition.

To assess the severity neurological symptoms in the acute ischemic period, the NIHSS scale is used. Thanks to the test, doctors are able to adequately assess the condition of an admitted person, which is necessary to provide competent first aid and determine the course of treatment.

What is this scale?

The international NIHSS scale was presented by the American National Institutes of Health (National Institutes of Health Stroke Scale). It is used to objectively assess the condition of a patient admitted to a hospital with an ischemic stroke. The test is carried out in the dynamics of the process and after 21 days of hospitalization.

The scale consists of 15 consecutive tests, each of which is scored from 0 to 4. Each study allows you to assess the state of the main functions that most often suffer from cerebral stroke. The test is simple, so it will take no more than 5-10 minutes to complete it.

The results of the test help the doctor assess the neurological status of the patient and determine the dynamics of his general condition in the acute phase of the disease.

Scale tests

As mentioned earlier, there are only 15 of them. We will consider each study further.

wakefulness level

The more cheerfully a person reacts, the lower the score is given to him. The maximum score is possible only in the case of coma or the complete absence of reactions and reflexes. So, the score depends on the reaction of the person:

• 0 - is awake and shows an active reaction;
• 1 - reacts slightly inhibited or feels drowsy, but fully responds to even minor stimuli;
• 2 - is in an unconscious state or a more aggressive impact is required for him to show a reaction;
• 3 - completely ignores external stimuli (may be associated with coma).

Ability to answer questions

The doctor asks the patient to clarify his age and the current month of the year. The score depends on the completeness and clarity of the answers:

• 0 - gave correct answers to 2 questions;
• 1 - answered correctly once;
• 2 - did not answer both questions.

It should be borne in mind that the patient must give accurate answers in numbers. The doctor records only the first uttered answer.

Command execution

The doctor invites the patient to perform a series of actions - close and open his eyes, put his fingers into a fist and unclench. If the patient cannot execute any command for one reason or another, for example, due to disability, another command must be given. If the patient does not respond to speech, you can show by example what is required of him. The first attempt to run the command is evaluated:

• 0 - both actions were completed successfully;
• 1 - only 1 action was performed;
• 2 - both actions are partially completed or not performed at all.

Eyeball response

You need to ask the patient to follow the movements of the finger with their eyes:

• 0 - normal reaction;
• 1 - partial paralysis of the eyeballs, but their fixed deviation is absent;
• 2 - complete paralysis with a fixed deviation of the eyeballs.

line of sight

The test is carried out using confrontation and counting the number of fingers, both from the periphery and from the center of the eyes:

• 0 - no violations recorded;
• 1 - there is asymmetry or partial 2-sided blindness in half of the field of view;
• 2 - complete.

facial muscles

It is determined how the facial nerve "works":

• 0 - no violations were recorded;
• 1 - there is a slight facial asymmetry;
• 2 - facial muscles are moderately paralyzed;
• 3 - facial muscles are completely paralyzed.

hand strength

It is important to note that this test is carried out for each hand separately, so two marks are given. As part of this task, the doctor asks the patient to open his arm, and then bend it at an angle of 90 (sitting) or 45 (lying) degrees. In this case, the palm must be turned down. The patient must withstand in this position for 10 seconds, after which a score is given:

• 0 - managed to keep the bent arm for all 10 seconds;
• 1 - the hand is initially held at a given angle, but gradually lowers;
• 2 - it is impossible to conduct a study, because the limb is missing or there is a fracture of the joint;
• 3 - the arm falls immediately, as it was bent, and it is not possible to overcome gravity;
• 4 - it is not possible to bend the arm at the right degree at all.

leg strength

Similar to the previous test, this study carried out for each leg separately. The patient must be in a supine position. The doctor asked him to raise his leg at an angle of 30 degrees and fix the position for 5 seconds. Then the score is given:

• 0 - the leg was at the right angle for all 5 seconds;
• 1 - gradually descended;
• 2 - descended faster, lingering at a given angle for an extremely short time;
• 3 - fell immediately, because the patient is not able to overcome gravity;
• 4 - did not manage to take the desired position at all.

Limb ataxia

This test is done to determine if there is a motor coordination disorder on one side. If the visual field is disturbed, the study is carried out on the side where there is no lesion. The doctor also conducts a knee-calcaneal and finger-nose-heel test. One of the following ratings is given:

• 0 - no violations were detected;
• 1 - there is ataxia in either the upper or lower extremities;
• 2 - ataxia of all limbs is observed.

Sensitivity level

To determine the level of sensitivity of the patient, the doctor uses touch and light piercing with a needle or pin. The score depends on the patient's response:

• 0 - feels all touches and piercings;
• 1 - weakly feels all the manipulations of the doctor;
• 2 - sensitivity is extremely low.

Speech

The specialist conducts a study to evaluate the patient. To do this, he is invited to describe the picture or read some text. If this is not possible, for example, due to vision problems, you can offer him to describe the object, having previously felt it with his hands.

The following ratings can be given:

• 0 - the task was completed correctly, that is, speech is normal;
• 1 - there is a partial violation of the speech apparatus;
• 3 - complete failure to complete the task or even the patient's coma.

dysarthria

The doctor establishes whether the patient's pronunciation is impaired as a result of a violation of the innervation of the speech apparatus due to damage nervous system(dysarthria). During this test, the doctor does not voice the area of ​​study, but simply conducts a dialogue with the patient. The following scores are given:

• 0 - the patient shows articulation within the norm and clearly answers questions;
• 1 - mild or moderate dysarthria is noted, that is, the patient slurs some words;
• 3 - complete dysarthria is noted, when the patient incomprehensibly pronounces all the words or is completely in a coma.

Neglect (ignore)

Right-hemispheric brain damage is often accompanied by neglekt - ignoring the person of the body, the affected limb or space. So, the test involves assessing the perception of half of the body (usually the left side). For this, touching, piercing with a needle or pin, etc. are also used. The following assessments are possible:

• 0 - the body responds adequately to stimuli, without showing signs of neglect;
• 1 - partial visual, auditory or tactful ignoring is noted;
• 2 - gross deviations from the norm are recorded;
• 3 - observed complete absence response to stimuli.

The patient cannot be pre-prepared for a specific task unless the test itself requires it.

Research results

The prognosis of a stroke is determined depending on the total score on the scale:

• 0 - there are no disorders in the neurological status;
• up to 10 - a good prognosis for recovery is given (observed in 60-70% of cases);
• more than 20 - a poor prognosis is given, since successful recovery is observed only in 4-16% of cases;
• 31 - the maximum increase in the risk of death.

According to the final assessment, the course of treatment is also adjusted. So, if there is a slight neurological deficit (overall score - above 3-5), then it is prescribed to prevent the development of the patient's disability. If there is a severe neurological deficit (overall score - 25), then thrombolysis is not prescribed, since it is no longer able to significantly affect the outcome of the disease and stop the development.

So, the scale under consideration consists of 15 tasks. For each of them, the doctor sets certain points, and testing is carried out sequentially, that is, you cannot change the established order of tasks or return to unfulfilled tests. After all the studies, the results are summed up, and the specialist gives a prognosis for the disease.