SCALES AND CLASSIFICATIONS - NEUROSURGERY

Coletânea das escalas e classificações mais úteis em neurocirurgia

Collection of more useful scales and classifications in neurosurgery

 

Karnowsky:

100% – normal, no complaints, no signs of disease
90% – capable of normal activity, few symptoms or signs of disease
80% – normal activity with some difficulty, some symptoms or signs
70% – caring for self, not capable of normal activity or work
60% – requiring some help, can take care of most personal requirements
50% – requires help often, requires frequent medical care
40% – disabled, requires special care and help
30% – severely disabled, hospital admission indicated but no risk of death
20% – very ill, urgently requiring admission, requires supportive measures or treatment

Wiltse Classification

Classification of Spondylolisthesis

1.) Dysplastic : Congenital malformation of the sacrum or neural arch of L5.
2.) Isthmic: Stress fracture, elongation, or acute fracture of the pars.
3.) Degenerative: Long-standing arthritic process of the zygapophyseal joints.
4.) Traumatic: Neural arch fracture excluding the pars region.
5.) Pathologic: Bone disease – Paget’s, Metastatic disease, or Osteopetrosis.
6.) Iatrogenic: Following lumbar spine surgery

Reference: Wiltse LL, Newman PH, Macnab I. “Classification of spondylolysis and spondylolisthesis.” Clin Orthop Relat Res. 1976 Jun;(117):23-9.

WFNS grade for SAH

Grade	GCS	Motor deficit
I	15	-
II	14-13	-
III	14-13	+
IV	12-7	+/-
V	6-3	+/-

Simpson grade for meningioma resection:

 

 

 

MRC scale

0 – no movement
1 – flicker is perceptible in the muscle
2 – movement only if gravity eliminated
3 – can move limb against gravity
4 – can move against gravity & some resistance exerted by examiner
5 – normal power

 

MODIC CHANGES:

 

Modified Rankin Scale

The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke.'

 

0	No symptoms at all
1	No significant disability despite symptoms; able to carry out all usual duties and activities
2	Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
3	Moderate disability; requiring some help, but able to walk without assistance
4	Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
5	Severe disability; bedridden, incontinent and requiring constant nursing care and attention
6	Dead

 

Escala de McCormick modificada para tumors espinhais

Modified McCormick scale
I	Intact neurologically, normal ambulation, minimal dyesthesia
II	Mild motor or sensory deficit, functional independence
III	Moderate deficit, limitation of function, independent w/external aid
IV	Severe motor or sensory deficit, limited function, dependent
V	Paraplegia or quadriplegia, even w/flickering movement

 

Meyerding grade

Spondylolisthesis

Categorises severity of spondylolisthesis based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:

§  Grade 1 is 0–25%

§  Grade 2 is 25–50%

§  Grade 3 is 50–75%

§  Grade 4 is 75–100%

§  Over 100% is Spondyloptosis, when the vertebra completely falls off the supporting vertebra.

 

Facial palsy in acoustic neuromas: House-Brackmann

 

 

 

 

Glasgow Outcome Scale

Outcome after sever brain damage

1. Dead

2. Persistent vegetative state (no obvious cortical function)

3. Severe disability (conscious but diabled)

 

4. Moderate disability (disabled but independent)

5. Good recovery (return to normal activities wvwn with minor neuro or psychological deficits)

 

 

Frankel Grade

Spinal Cord Function

A complete paralysis
B sensory function only below the injury level
C incomplete motor function below injury level
D fair to good motor function below injury level
E normal function

 

Fischer:

 

Cervical Myelopathy

1. Nurick’s classification system for myelopathy on the basis of gait abnormalities

Grade	Root signs	Cord involvement	Gait	Employment
0	Yes	No	Normal	Possible
I	Yes	Yes	Normal	Possible
II	Yes	Yes	Mild abnormality	Possible
III	Yes	Yes	Severe abnormality	Impossible
IV	Yes	Yes	Only with assistance	Impossible

Reference: Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87-100

2. Ranawat Classification of Neurologic Deficit

Asia

Muscle strength is graded as

§  0 Total paralysis

§  1 - Palpable or visible contraction

§  2 - Active movement, full range of motion, gravity eliminated

§  3 - Active movement, full range of motion, against gravity

§  4 - Active movement, full range of motion, against gravity and provides some resistance

§  5 – Active movement, full range of motion, against gravity and provides normal resistance [Muscle able to exert, in examiner’s judgement, sufficient resistance to be considered normal if identifiable inhibiting factors were not present]

§  NT – not testable. Patient unable to reliably exert effort or muscle unavailable for test-ing due to factors such as immobilization, pain on effort or contracture.

 

 

ASA

  Presurgical condition for anaesthesia

§  1. Normal healthy patient

§  2. Mild systemic disease

§  3. Severe systemic disease

§  4. Severe systemic disease that is a constant threat to life

§  5. Moribund patient, not expected to survive the operation

§  6. Declare brain-dead patient whose organs are being removed for donor purposes

§  Reference: http://en.wikipedia.org/wiki/ASA_physical_status_classification_system

 

Hunt-Hess

Spetzler e Martin:

 

The Spetzler-Martin AVM grading system allocates points for various features of intracranial AVM's to give a score between 1 and 5. Grade 6 is used to describe inoperable lesions. The score correlates with operative outcome.

The grading system

• size of nidus
  • small (<3cm) = 1
  • medium (3 - 6cm) = 2
  • large (> 6cm) = 3
• eloquence of adjacent brain
  • non-eloquent = 0
  • eloquent = 1
• venous drainage
  • superficial only = 0
  • deep = 1

http://radiopaedia.org/articles/spetzler-martin-avm-grading-system

 

 

 

 

 

Dr. Bernardo de Andrada

 

CASO ADRIELLY

 

CASO ADRIELLY

Ponto eletrônico, esquemas, omissão ! Essas palavras tornaram-se comuns nos últimos dias quando a falha no atendimento médico ficou em evidência. O caso teve imensa repercussão na mídia que vem tratando os médicos estatutários como se fossem bandidos mafiosos.

A atual prefeitura está desmontando o modelo atual de médicos concursados e tentando privatizar os hospitais públicos através de Organizações Sociais. No mesmo ambiente de trabalho um concursado recebe um terço do salário de um contratado, sendo que ambos exercem exatamente a mesma função, isso só pode resultar na desmotivação profissional.
...
Ficou claro mais uma vez que o modelo do SUS seria perfeito se não fosse administrado por homens e não tivesse dinheiro a vista. Espero que esse espaço na mídia possa ser aproveitado para exigirmos uma melhor remuneração e valorizarmos a classe. Os grandes beneficiados não serão só os médicos, será o povo que receberá um melhor tratamento.

Vamos levantar a discussão e repensar sobre a atenção médica: SUS, seguros de saúde, médicos insatisfeitos e desvalorizados, formação nas faculdades, residência médica, especialização, médicos estrangeiros, programa de saúde da família. É preciso refletir, repensar, discutir e reformar o modelo atual e essa é a hora.

Para a mídia fica o recado: Nos hospitais públicos municipais do Rio todos os anos são muitos pacientes operados, curados e satisfeitos, principalmente com os médicos que o assistiram, seria interessante mostrar isso também.

 

Dr. Bernardo de Andrada