Canadian Neurological Scale

Last revised by Assoc Prof Craig Hacking on 20 Oct 2020

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.

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. 

  • 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)
  • 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)
  • face: symmetrical (0.5), asymmetrical (0)
  • arms: equal (1.5), unequal (0)
  • legs: equal (1.5), unequal (0)

Scores range from 1.5 to 11.5, with a lower score indicating greater stroke severity.

The Canadian Stroke Scale can be converted 3 to the National Institutes of Health Stroke Scale (NIHSS) using NIHSS = 23 - 2 x CNS

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