Canadian Neurological Scale
Disclosures
- updated 21 Oct 2023:
Nothing to disclose
Updates to Article Attributes
Body
was changed:
The Canadian Neurological Scale is a validated tool to evaluate stroke severity 1,2 designed to be performed on patients who are alert or drowsy. Patients who are stuporous or comatose are evaluated with the Glasgow Coma Scale (GCS) instead.
Classification
Section A is completed first. In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present or not.
Section A – patient alert or drowsy
Mentation
level of consciousness: alert (3), drowsy (1.5)
orientation:
orientedorientated (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 proximal: none (1.5), mild (1), significant (0.5), total (0)
leg distal: 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 GCS
Interpretation
Scores range from 1.5 to 11.5, with a lower score indicating greater stroke severity.
Practical points
The Canadian Stroke Scale can be converted 3 to the National Institutes of Health Stroke Scale (NIHSS) using NIHSS = 23 - 2 x CNS
-<p>The<strong> Canadian Neurological Scale</strong> is a validated tool to evaluate <a href="/articles/stroke">stroke</a> severity <!--[if supportFields]><span style='mso-element:field-begin;-mso-field-lock:yes'></span>ADDIN CSL_CITATION-{"citationItems":[{"id":"ITEM-1","itemData":{"abstract":"Acute-central nervous system dysfunction resulting in coma can be measured simply and-reliably by the Glasgow scale. However, when the injury does not impair-consciousness and the patient has aphasia, no comparable scale exists. A-complementary scale to assess conscious and aphasic patients is proposed.-Preliminary validation has been carried out in acute stroke patients, who-commonly suffer neurological deficits without loss of consciousness. A simple-standardized scale aids hi the monitoring of neurological status, and may help-in the assessment of prognosis and therapy.","author":[{"dropping-particle":"","family":"Cote","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hachinski","given":"Vladimir-C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shurvell","given":"Bette-L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Norris","given":"John-W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"And","given":":","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wolfson","given":"Christina","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Stroke","id":"ITEM-1","issued":{"date-parts":[["1986"]]},"title":"The-Canadian Neurological Scale: A Preliminary Study in Acute-Stroke","type":"report","volume":"17"},"uris":["http://www.mendeley.com/documents/?uuid=dc07eb7a-0894-3371-8f00-e22ed669a7da"]},{"id":"ITEM-2","itemData":{"DOI":"10.1212/wnl.39.5.638","ISSN":"1526632X","PMID":"2710353","abstract":"The-Canadian Neurological Scale (CNS) was designed to monitor mentation and motor-functions in stroke patients. We assessed its validity and reliability on a-group of 157 patients with a diagnosis of acute cerebrovascular accident. We-determined validity by (1) correlating scale items and total score with the-standard neurologic examination; (2) exploring the scale’s predictive power-with different end points at 6 months—the initial CNS was a significant-predictor of outcome; (3) showing that the CNS had higher correlation-coefficients with the initial neurologic examination than the Glasgow Coma-Scale; and (4) assesseing the responsiveness of the scale to change in the neurologic-status of stroke patients. Interobserver reliability, measured by kappa-statistics on each scale item, was good. Accordingly, we established the-validity and reliability of the CNS for ita use in clinical studies and in the-care of stroke patients. © 1989 American Academy of-Neurology.","author":[{"dropping-particle":"","family":"Côté","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Battista","given":"R.-N.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wolfson","given":"C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boucher","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Adam","given":"J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hachinski","given":"V.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Neurology","id":"ITEM-2","issue":"5","issued":{"date-parts":[["1989"]]},"page":"638-643","publisher":"Neurology","title":"The-Canadian neurological scale: Validation and reliability-assessment","type":"article-journal","volume":"39"},"uris":["http://www.mendeley.com/documents/?uuid=56e2a888-e3a2-3dfa-b87b-96273478ae03"]}],"mendeley":{"formattedCitation":"<sup>1</sup>,<sup>2</sup>","plainTextFormattedCitation":"1,2","previouslyFormattedCitation":"<sup>1</sup>,<sup>2</sup>"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<span-style='mso-element:field-separator'></span><![endif]--><sup>1,2 </sup>designed to be performed on patients who are alert or drowsy. Patients who are stuporous or comatose are evaluated with the <a href="/articles/glasgow-coma-scale-1">Glasgow Coma Scale (GCS)</a> instead.</p><h4>Classification</h4><p>Section A is completed first. In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present or not. </p><h5>Section A – patient alert or drowsy</h5><h6>Mentation</h6><ul>-<li>level of consciousness: alert (3), drowsy (1.5)</li>-<li>orientation: oriented (1), disoriented or non-applicable (0)</li>-<li>speech: normal (1), expressive deficit(0.5), receptive deficit (0)</li>- +<p>The<strong> Canadian Neurological Scale</strong> is a validated tool to evaluate <a href="/articles/stroke">stroke</a> severity <sup>1,2 </sup>designed to be performed on patients who are alert or drowsy. Patients who are stuporous or comatose are evaluated with the <a href="/articles/glasgow-coma-scale-1">Glasgow Coma Scale (GCS)</a> instead.</p><h4>Classification</h4><p>Section A is completed first. In the second part of the scale calculation, either section A1 or A2 is completed depending on whether a comprehension deficit is present or not. </p><h5>Section A – patient alert or drowsy</h5><h6>Mentation</h6><ul>
- +<li><p>level of consciousness: alert (3), drowsy (1.5)</p></li>
- +<li><p>orientation: orientated (1), disoriented or non-applicable (0)</p></li>
- +<li><p>speech: normal (1), expressive deficit (0.5), receptive deficit (0)</p></li>
-<li>face: none (0.5), present (0)</li>-<li>arm proximal: none (1.5), mild (1), significant (0.5), total (0)</li>-<li>arm distal: none (1.5), mild (1), significant (0.5), total (0)</li>-<li>leg: none (1.5), mild (1), significant (0.5), total (0)</li>- +<li><p>face: none (0.5), present (0)</p></li>
- +<li><p>arm proximal: none (1.5), mild (1), significant (0.5), total (0)</p></li>
- +<li><p>arm distal: none (1.5), mild (1), significant (0.5), total (0)</p></li>
- +<li><p>leg proximal: none (1.5), mild (1), significant (0.5), total (0)</p></li>
- +<li><p>leg distal: none (1.5), mild (1), significant (0.5), total (0)</p></li>
-<li>face: symmetrical (0.5), asymmetrical (0)</li>-<li>arms: equal (1.5), unequal (0)</li>-<li>legs: equal (1.5), unequal (0)</li>-</ul><h5>Section B – patient stuporous or comatose</h5><ul><li>use <a href="/articles/glasgow-coma-scale-1">GCS</a>-</li></ul><h4>Interpretation</h4><p>Scores range from 1.5 to 11.5, with a lower score indicating greater stroke severity.</p><h4>Practical points</h4><p>The Canadian Stroke Scale can be converted <sup>3</sup> to the <a href="/articles/national-institutes-of-health-stroke-scale-nihss-2">National Institutes of Health Stroke Scale</a><a href="/articles/national-institutes-of-health-stroke-scale-nihss-2"> (NIHSS)</a> using NIHSS = 23 - 2 x CNS</p>- +<li><p>face: symmetrical (0.5), asymmetrical (0)</p></li>
- +<li><p>arms: equal (1.5), unequal (0)</p></li>
- +<li><p>legs: equal (1.5), unequal (0)</p></li>
- +</ul><h5>Section B – patient stuporous or comatose</h5><ul><li><p>use <a href="/articles/glasgow-coma-scale-1">GCS</a></p></li></ul><h4>Interpretation</h4><p>Scores range from 1.5 to 11.5, with a lower score indicating greater stroke severity.</p><h4>Practical points</h4><p>The Canadian Stroke Scale can be converted <sup>3</sup> to the <a href="/articles/national-institutes-of-health-stroke-scale-1">National Institutes of Health Stroke Scale (NIHSS)</a> using NIHSS = 23 - 2 x CNS</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>
- 1. Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian Neurological Scale: A Preliminary Study in Acute Stroke. Vol. 17, Stroke. 1986.
- 2. Côté R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V. The Canadian neurological scale: Validation and reliability assessment. Neurology. 1989.
- 3. Nilanont Y, Komoltri C, Saposnik G, Côté R, Di Legge S, Jin Y, et al. The Canadian Neurological Scale and the NIHSS: Development and Validation of a Simple Conversion Model. Cerebrovasc Dis. 2010 Jul 22;30(2):120–6.
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