Grading Systems

Question 1

Describe the eye scoring for the Glasgow Coma Scale

Answer 1

4 = open spontaneously
3 = to verbal stimulation
2 = to pain
1 = don't open

Question 2

Describe the motor scoring for the Glasgow Coma Scale

Answer 2

6 = obeys commands
5 = localizes pain
4 = flexion withdrawal
3 = decorticate rigidity (abnormal flexion)
2 = decerebrate rigidity (extension)
1 = no movement

Question 3

Describe the verbal scoring for the Glasgow Coma Scale

Answer 3

5 = oriented and converses
4 = disoriented and converses
3 = inappropriate words
2 = incomprehensible sounds
1 = no speech

Question 4

What does the Hunt-Hess scale describe and what is it a predictor of?

Answer 4

• Describes severity of SAH

- Predictor of prognosis/outcomes

Question 5

Hunt-Hess Grade 1

Answer 5

• Asymptomatic/minimal headache with neck stiffness

- 70% survival

Question 6

Hunt-Hess Grade 2

Answer 6

• Moderate/severe headache, neck stiffness
• No neuro deficits except for cranial nerve palsy
• 60% survival

Question 7

Hunt-Hess Grade 3

Answer 7

• Drowsy with neurologic deficit

- 50% survival

Question 8

Hunt-Hess Grade 4

Answer 8

• Stuporous, moderate/severe hemiparesis
• Possible early decerebrate rigidity and vegetative disturbances
• 20% survival

Question 9

Hunt-Hess Grade 5

Answer 9

• Deep coma, decerebrate, moribund

- 10% survival

Question 10

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?

Answer 10

• 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

Question 11

Modified Fisher Scale Group 1

Answer 11

Focal or diffuse, thin SAH, no IVH

Question 12

Modified Fisher Scale Group 2

Answer 12

Focal or diffuse, thin (

Question 13

Modified Fisher Scale Group 3

Answer 13

Focal or diffuse, thick (>1mm) SAH, no IVH

Question 14

Modified Fisher Scale Group 4

Answer 14

Focal or diffuse, thick (>1mm) SAH, with IVH

Question 15

Modified Fisher Scale Group 0

Answer 15

No SAH or IVH

Question 16

What does the World Federation of Neurosurgical Societies (WFNS) grading system describe and predict?

Answer 16

Severity of SAH based on GCS and neurological deficits; used to predict outcomes

Question 17

WFNS Grade 1

Answer 17

GCS 15

Question 18

WFNS Grade 2

Answer 18

GSC 13-14 without deficit

Question 19

WFNS Grade 3

Answer 19

GCS 13-14 with focal neurologic deficit

Question 20

WFNS Grade 4

Answer 20

GCS 7-12

Question 21

WFNS Grade 5

Answer 21

GCS

Question 22

What does the Spetzler-Martin grading scale describe and what does it correlate with?

Answer 22

A point system used to describes intracranial AVMs and correlating with operative outcomes

Question 23

In the Spetzler-Martin grading system how are points allocated for the size of the AVM nidus?

Answer 23

Small (6cm) = 3

Question 24

in the Spetzler-Martin grading system how are points allocated for eloquence of adjacent brain?

Answer 24

Eloquent brain (or adjacent) = 1
Non-eloquent = 0

Question 25

In the Spetzler-Martin grading system how are points allocated for venous drainage?

Answer 25

Deep venous drainage = 1 | Superficial venous drainage only = 0

Question 26

What is the American Spinal Injury Association (ASIA) impairment scale used for?

Answer 26

Grading the extent and severity of spinal injury

Question 27

ASIA A

Answer 27

Complete: complete lack of motor and sensory abilities below injured spinal level

Question 28

ASIA B

Answer 28

Incomplete: some sensory function is preserved below injured spinal level (including anal sensation) but no motor response below

Question 29

ASIA C

Answer 29

Incomplete: motor function is preserved below level of spinal injury but more than half of key muscles have strength

Question 30

ASIA D

Answer 30

Incomplete: motor function preserved below level of injury with more than half of key muscles having strength > 3

Question 31

ASIA E

Answer 31

Normal

Question 32

Describe the following for muscle strength grading: ``` 0: 1: 2: 3: 4: 5: ```

Answer 32

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

Question 33

What is grading of diffuse axonal injury (DAI) is primarily based off and what does it correlate with?

Answer 33

Based off anatomic distribution and correlates with outcome

Question 34

Grade I DAI

Answer 34

Involves grey-white matter interface and more commonly in parasagittal frontal or periventricular temporal lobes (may not see on conventional imaging)

Question 35

Grade II DAI

Answer 35

Involves corpus callosum (commonly posterior body and splenium but advances anteriorly with injury severity) as well as grade I locations

Question 36

Grade III DAI

Answer 36

Involves brainstem in addition to Grade I and II locations (commonly rostral midbrain, superior cerebellat peduncles, medial lemnisci, and corticospinal tracts)