Canadian Neurological Scale
Updates to Article Attributes
The Canadian Neurological Scale(CNS) is a validated tool to evaluate stroke severity1,2. Designed to be performed on patients who are alert or drowsy, scores range from 1.5 – 11.5, with a lower score indicating greater stroke severity. Patients who are stuporous or comatose are evaluated with the Glasgow Coma Scale instead.
The Canadian Stroke Scale can be converted3 to the National Institutes of Health Stroke Scale (NIHSS) using NIHSS = 23 - 2 x CNS.
In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present.
Scale description
Section A – Patient alert or drowsy
Mentation
Level of consciousness: alert (3), drowsy (1.5)
Orientation: oriented (1), disoriented or non-applicable (0)
Speech: normal (1), expressive deficit(0.5), receptive deficit (0)
Section A1 – No comprehension deficit
Motor weakness
Face: none(0.5), present(0)
Arm proximal: none(1.5), mild (1), significant (0.5), total(0)
Arm distal: none(1.5), mild (1), significant (0.5), total(0)
Leg: none(1.5), mild (1), significant (0.5), total(0)
Section A2 - Comprehension deficit
Motor response
Face: symmetrical (0.5), asymmetrical(0)
Arms: equal (1.5), unequal(0)
Legs: equal(1.5), unequal(0)
Section B – Patient stuporous or comatose
Use Glasgow Coma Scale
-style='mso-element:field-end'></span><![endif]--> to the National Institutes of Health Stroke Scale (NIHSS) using NIHSS = 23 - 2 x CNS.</p><p>In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present.</p><h4>Scale description</h4><h5><strong>Section A – Patient alert or drowsy</strong></h5><p><strong>Mentation</strong></p><p>Level of consciousness: alert (3), drowsy (1.5)</p><p>Orientation: oriented (1), disoriented or non-applicable (0)</p><p>Speech: normal (1), expressive deficit(0.5), receptive deficit (0)</p><p> </p><h5><strong>Section A1 – No comprehension deficit</strong></h5><p><strong>Motor weakness</strong></p><p>Face: none(0.5), present(0)</p><p>Arm proximal: none(1.5), mild (1), significant (0.5), total(0)</p><p>Arm distal: none(1.5), mild (1), significant (0.5), total(0)</p><p>Leg: none(1.5), mild (1), significant (0.5), total(0)</p><p> </p><h5><strong>Section A2 - Comprehension deficit</strong></h5><p><strong>Motor response</strong></p><p>Face: symmetrical (0.5), asymmetrical(0)</p><p>Arms: equal (1.5), unequal(0)</p><p>Legs: equal(1.5), unequal(0)</p><p> </p><h5><strong>Section B – Patient stuporous or comatose</strong></h5><p>Use Glasgow Coma Scale</p><p> </p>- +style='mso-element:field-end'></span><![endif]--> to the <a href="/articles/national-institutes-of-health-stroke-scale-nihss-2">National Institutes of Health Stroke Scale</a> (NIHSS) using NIHSS = 23 - 2 x CNS.</p><p>In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present.</p><h4>Scale description</h4><h5><strong>Section A – Patient alert or drowsy</strong></h5><p><strong>Mentation</strong></p><p>Level of consciousness: alert (3), drowsy (1.5)</p><p>Orientation: oriented (1), disoriented or non-applicable (0)</p><p>Speech: normal (1), expressive deficit(0.5), receptive deficit (0)</p><p> </p><h5><strong>Section A1 – No comprehension deficit</strong></h5><p><strong>Motor weakness</strong></p><p>Face: none(0.5), present(0)</p><p>Arm proximal: none(1.5), mild (1), significant (0.5), total(0)</p><p>Arm distal: none(1.5), mild (1), significant (0.5), total(0)</p><p>Leg: none(1.5), mild (1), significant (0.5), total(0)</p><p> </p><h5><strong>Section A2 - Comprehension deficit</strong></h5><p><strong>Motor response</strong></p><p>Face: symmetrical (0.5), asymmetrical(0)</p><p>Arms: equal (1.5), unequal(0)</p><p>Legs: equal(1.5), unequal(0)</p><p> </p><h5><strong>Section B – Patient stuporous or comatose</strong></h5><p>Use Glasgow Coma Scale</p><p> </p>
References changed:
- 1. Côté R, Hachinski V, Shurvell B, Norris J, Wolfson C. The Canadian Neurological Scale: A Preliminary Study in Acute Stroke. Stroke. 1986;17(4):731-7. <a href="https://doi.org/10.1161/01.str.17.4.731">doi:10.1161/01.str.17.4.731</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3738958">Pubmed</a>
- 2. Côté R, Battista R, Wolfson C, Boucher J, Adam J, Hachinski V. The Canadian Neurological Scale: Validation and Reliability Assessment. Neurology. 1989;39(5):638-43. <a href="https://doi.org/10.1212/wnl.39.5.638">doi:10.1212/wnl.39.5.638</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/2710353">Pubmed</a>
- 3. Nilanont Y, Komoltri C, Saposnik G et al. The Canadian Neurological Scale and the NIHSS: Development and Validation of a Simple Conversion Model. Cerebrovasc Dis. 2010;30(2):120-6. <a href="https://doi.org/10.1159/000314715">doi:10.1159/000314715</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20501997">Pubmed</a>
Tags changed:
- stroke
- cerebrovascular accident
- cerebral infarction
- ischaemia
Systems changed:
- Central Nervous System
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