Stroke Scales
Stroke scales are standardized tools used to assess various aspects of stroke, including severity, functional status, prognosis, and treatment eligibility.
1. NIH Stroke Scale (NIHSS)
- Purpose: Quantifies neurological deficit in acute stroke.
- Range: 0–42
- Interpretation:
- 0 = No stroke symptoms
- 1–4 = Minor stroke
- 5–15 = Moderate stroke
- 16–20 = Moderate to severe stroke
- 21–42 = Severe stroke
- Use: Inclusion/exclusion in thrombolysis and thrombectomy trials.
2. Modified Rankin Scale (mRS)
- Purpose: Measures degree of disability or dependence after stroke.
- Range: 0–6
- Interpretation:
- 0 = No symptoms
- 1 = No significant disability despite symptoms
- 2 = Slight disability
- 3 = Moderate disability
- 4 = Moderately severe disability
- 5 = Severe disability
- 6 = Death
- Use: Common endpoint in stroke trials.
3. Glasgow Coma Scale (GCS)
- Purpose: Assesses level of consciousness.
- Range: 3–15
- Components: Eye (4), Verbal (5), Motor (6)
- Use: Useful in hemorrhagic stroke or coma.
4. ASPECTS (Alberta Stroke Program Early CT Score)
- Purpose: Quantifies early ischemic changes on non-contrast head CT.
- Range: 0–10
- Lower score = More extensive ischemia
- Use: Selection for thrombectomy (particularly in anterior circulation).
5. TICI (Thrombolysis in Cerebral Infarction)
- Purpose: Grades reperfusion after thrombectomy.
- Range:
- 0 = No perfusion
- 1 = Minimal
- 2a = Partial (<50%)
- 2b = Substantial (>50%)
- 2c = Near complete
- 3 = Complete
- Use: Angiographic outcome measurement.
6. Barthel Index
- Purpose: Measures functional independence in activities of daily living (ADLs).
- Range: 0–100
- Use: Rehab planning and long-term prognosis.
7. ABCD2 Score
- Purpose: Predicts risk of stroke after TIA.
- Factors: Age, BP, Clinical features, Duration, Diabetes
- Range: 0–7
- Risk stratification:
- 0–3 = Low
- 4–5 = Moderate
- 6–7 = High
8. SPAN-100 Index
- Purpose: Estimates risk/benefit from thrombolysis in elderly.
- Calculation: Age + NIHSS
- SPAN-100 positive = total ≥100 → high risk of sICH (symptomatic ICH)
9. ICH Score
- Purpose: Predicts 30-day mortality in intracerebral hemorrhage.
- Factors: GCS, ICH volume, age, location, IVH
- Range: 0–6
10. TOAST Classification
- Purpose: Etiological classification of ischemic stroke.
- Categories:
- Large-artery atherosclerosis
- Cardioembolism
- Small vessel occlusion (lacune)
- Other determined etiology
- Undetermined etiology