Global cortical atrophy scale

The global cortical atrophy (GCA) scale, also known as the Pasquier scale, is a qualitative rating system developed to assess cerebral atrophy, especially in the context of neurodegenerative diseases. It evaluates atrophy in 13 brain regions assessed separately in each hemisphere and resulting in a final score that is the sum of all regions 1

The thirteen brain regions evaluated are:

  • sulcal dilatation
    • frontal (right and left)
    • parieto-occipital (right and left)
    • temporal (right and left)
  • ventricular dilatation 
    • frontal (right and left)
    • parieto-occipital (right and left)
    • temporal (right and left)
    • third ventricle 

The score for each region can range from 0 to 3 accordingly to the following criteria:

  • 0: normal volume/no ventricular enlargement
  • 1: opening of sulci/mild ventricular enlargement
  • 2: volume loss of gyri/moderate ventricular enlargement
  • 3: 'knife blade' atrophy/severe ventricular enlargement

After the original publication, other studies have proposed a simplification of the Pasquier scale to provide a more general impression of atrophy throughout the brain, making it easier and more accepted 2. It is important to note that this tool is only a component part of a larger diagnostic assessment in neurodegenerative diseases (for a broad discussion, please refer on neurodegenerative MRI brain (an approach)).

History and etymology

The scale was described in 1997 by Florence Pasquier, a French neurologist, as a tool to quantify atrophy in patients after stroke 1

Neurodegenerative diseases

Neurodegenerative diseases are legion and their classification just as protean. A useful approach is to divide them according to underlying pathological process, although even using this schema, there is much overlap and thus resulting confusion.

Share article

Article information

rID: 37584
Tag: refs, cases
Synonyms or Alternate Spellings:
  • Pasquier scale
  • Global cortical atrophy (GCA) scale
  • GCA scale

Support Radiopaedia and see fewer ads

Updating… Please wait.

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.