How Is the Severity of a Stroke Determined?
When a stroke occurs, getting emergency care is of the utmost importance. The sooner a patient receives stroke care, the better his or her chances of survival and favorable long-term outcomes. As soon as a stroke patient arrives at Regional Medical Center of San Jose, our stroke care team rapidly assesses him or her using established guidelines.
The first set of assessment criteria involves the patient’s level of consciousness. The clinician scores the patient from zero to three, with zero indicating full alertness and responsiveness, and three indicating complete unresponsiveness to stimuli. If the patient is conscious, the clinician asks for the patient’s age and what month it is. A score of zero indicates both answers are correct, one means that one answer is correct, and two means that neither answer is correct. The last level of consciousness assessment tests how well the patient can follow simple commands. The patient is asked to open and close the eyes, and then to grip and release the unaffected hand.
The clinician evaluates the patient’s horizontal eye movements , such as by making eye contact with the patient and then encouraging eye movement by physically moving from one side of the patient’s visual field to the other. Zero indicates a normal gaze, one indicates partial gaze palsy, and two indicates total gaze palsy.
The clinician then checks the patient’s visual field. He or she holds up a finger and moves it across the upper and lower quadrants of the visual field. This assessment of possible vision loss is crucial, because stroke may result in blindness.
Since stroke can cause weakness or paralysis on one side of the body, the clinician asks the patient to smile or raise the eyebrows to check for symmetry. If the patient is poorly responsive, the clinician may use stimuli to trigger a grimace response instead.
The last set of assessment criteria involves lifting each arm and leg in turn. The patient is asked to keep the limb in the elevated position. The clinician scores the patient based on whether the limb stays up, drifts downward, or falls immediately.
Protocols-driven stroke care is available from Regional Medical Center of San Jose. Our stroke care team coordinates with EMS personnel to prepare for a patient’s arrival to facilitate immediate evaluations and interventions. We urge residents of San Jose to call 911 for emergency care if stroke signs develop; general questions of a non-emergent nature can be directed to our hospital at (888) 762-8881.