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Departments of Neurology and Neurosurgery, McGill University, Montreal, Quebec (Drs. Côté and Wolfson)
Departments of Epidemiology and Biostatistics (Drs. Battista and Wolfson), McGill University, Montreal, Quebec
Divisions of Neurology, Montreal General Hospital, Montreal, Quebec (Dr. Côté)
Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec (Drs. Côté and Battista, Ms. Boucher, and Ms. Adam)
Investigative Stroke Unit, University Hospital, London, Ontario, Canada (Dr. Hachinski).
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) assessing 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 its use in clinical studies and in the care of stroke patients.
Address correspondence and reprint requests to Dr. Côté, Division of Clinical Epidemiology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, PQ H3G 1A4, Canada.
Supported in part by the Fonds de la recherche en santé du Québec (FRSQ), and by the Québec Heart Foundation. Dr. Battista is a Research Scholar of the National Health Research and Development Program, Ottawa. Dr. Hachinski is a Career Investigator of the Heart and Stroke Foundation of Ontario.
Received August 31, 1988. Accepted for publication in final form November 28, 1988.
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M. W. Parsons, T. Li, P. A. Barber, Q. Yang, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis Combined 1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome Neurology, August 22, 2000; 55(4): 498 - 506. [Abstract] [Full Text] [PDF]
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M. Bragoni, C. Caltagirone, E. Troisi, M. Matteis, F. Vernieri, and M. Silvestrini Correlation of cerebral hemodynamic changes during mental activity and recovery after stroke Neurology, July 12, 2000; 55(1): 35 - 40. [Abstract] [Full Text] [PDF]
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R. Barba, S. Martinez-Espinosa, E. Rodriguez-Garcia, M. Pondal, J. Vivancos, and T. Del Ser Poststroke Dementia : Clinical Features and Risk Factors Stroke, July 1, 2000; 31(7): 1494 - 1501. [Abstract] [Full Text] [PDF]
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P. W. Duncan, H. S. Jorgensen, and D. T. Wade Outcome Measures in Acute Stroke Trials : A Systematic Review and Some Recommendations to Improve Practice Stroke, June 1, 2000; 31(6): 1429 - 1438. [Abstract] [Full Text] [PDF]
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N. E. Mayo, S. Wood-Dauphinee, R. Cote, D. Gayton, J. Carlton, J. Buttery, and R. Tamblyn There's No Place Like Home : An Evaluation of Early Supported Discharge for Stroke Stroke, May 1, 2000; 31(5): 1016 - 1023. [Abstract] [Full Text] [PDF]
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A. Davalos, J. Castillo, J. Marrugat, J. M. Fernandez-Real, A. Armengou, P. Cacabelos, and R. Rama Body iron stores and early neurologic deterioration in acute cerebral infarction Neurology, April 25, 2000; 54(8): 1568 - 1574. [Abstract] [Full Text] [PDF]
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Q. Yang, B. M. Tress, P. A. Barber, P. M. Desmond, D. G. Darby, R. P. Gerraty, T. Li, and S. M. Davis Serial Study of Apparent Diffusion Coefficient and Anisotropy in Patients With Acute Stroke Stroke, November 1, 1999; 30(11): 2382 - 2390. [Abstract] [Full Text] [PDF]
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P. A. Barber, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, T. Li, D. Jolley, G. A. Donnan, B. M. Tress, and S. M. Davis Identification of Major Ischemic Change : Diffusion-Weighted Imaging Versus Computed Tomography Stroke, October 1, 1999; 30(10): 2059 - 2065. [Abstract] [Full Text] [PDF]
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M. Weih, K. Kallenberg, A. Bergk, U. Dirnagl, L. Harms, K. D. Wernecke, and K. M. Einhaupl Attenuated Stroke Severity After Prodromal TIA : A Role for Ischemic Tolerance in the Brain? Stroke, September 1, 1999; 30(9): 1851 - 1854. [Abstract] [Full Text] [PDF]
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B. Infeld, S. M. Davis, G. A. Donnan, M. Yasaka, M. Lichtenstein, P. J. Mitchell, and G. J. Fitt Nimodipine and Perfusion Changes After Stroke Stroke, July 1, 1999; 30(7): 1417 - 1423. [Abstract] [Full Text] [PDF]
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P. A. Barber, S. M. Davis, D. G. Darby, P. M. Desmond, R. P. Gerraty, Q. Yang, D. Jolley, G. A. Donnan, and B. M. Tress Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra Neurology, April 1, 1999; 52(6): 1125 - 1125. [Abstract] [Full Text] [PDF]
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 B Panayiotou, J Reid, M Fotherby, and P Crome Orthostatic haemodynamic responses in acute stroke Postgrad. Med. J., April 1, 1999; 75(882): 213 - 218. [Abstract] [Full Text]
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D. A Forlander and R. W Bohannon Rivermead Mobility Index: a brief review of research to date Clinical Rehabilitation, February 1, 1999; 13(2): 97 - 100. [Abstract] [PDF]
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P. A. Barber, S. M. Davis, B. Infeld, A. E. Baird, G. A. Donnan, D. Jolley, and M. Lichtenstein Spontaneous Reperfusion After Ischemic Stroke Is Associated With Improved Outcome Stroke, December 1, 1998; 29(12): 2522 - 2528. [Abstract] [Full Text] [PDF]
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R. T.F. Cheung, D. Toni, M. Fiorelli, and C. Argentino Predicting Early Deterioration or Improvement in Ischemic Stroke by Transcranial Doppler • Response Stroke, November 1, 1998; 29(11): 2443 - 2444. [Full Text] [PDF]
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M. Kelly-Hayes, J. T. Robertson, J. P. Broderick, P. W. Duncan, L. A. Hershey, E. J. Roth, W. H. Thies, and C. A. Trombly The American Heart Association Stroke Outcome Classification: Executive Summary Circulation, June 23, 1998; 97(24): 2474 - 2478. [Full Text] [PDF]
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P. M. Kelly-Hayes, J. T. Robertson, J. P. Broderick, P. W. Duncan, L. A. Hershey, E. J. Roth, W. H. Thies, and C. A. Trombly The American Heart Association Stroke Outcome Classification Stroke, June 1, 1998; 29(6): 1274 - 1280. [Full Text] [PDF]
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L. Morfis, R. S. Schwartz, R. Poulos, and L. G. Howes Blood Pressure Changes in Acute Cerebral Infarction and Hemorrhage Stroke, July 1, 1997; 28(7): 1401 - 1405. [Abstract] [Full Text]
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L. B. Goldstein and V. Chilukuri Retrospective Assessment of Initial Stroke Severity With the Canadian Neurological Scale Stroke, June 1, 1997; 28(6): 1181 - 1184. [Abstract] [Full Text]
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A. V. Alexandrov, S. E. Black, L. E. Ehrlich, C. B. Caldwell, and J. W. Norris Predictors of Hemorrhagic Transformation Occurring Spontaneously and on Anticoagulants in Patients With Acute Ischemic Stroke Stroke, June 1, 1997; 28(6): 1198 - 1202. [Abstract] [Full Text]
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D. Toni, M. Fiorelli, S. Bastianello, A. Falcou, G. Sette, V. Ceschin, M. L. Sacchetti, and C. Argentino Acute Ischemic Strokes Improving During the First 48 Hours of Onset: Predictability, Outcome, and Possible Mechanisms: A Comparison With Early Deteriorating Strokes Stroke, January 1, 1997; 28(1): 10 - 14. [Abstract] [Full Text]
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L. D'Olhaberriague, I. Litvan, P. Mitsias, and H. H. Mansbach A Reappraisal of Reliability and Validity Studies in Stroke Stroke, December 1, 1996; 27(12): 2331 - 2336. [Abstract] [Full Text]
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K. W. Muir, C. J. Weir, G. D. Murray, C. Povey, and K. R. Lees Comparison of Neurological Scales and Scoring Systems for Acute Stroke Prognosis Stroke, October 1, 1996; 27(10): 1817 - 1820. [Abstract] [Full Text]
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B. Infeld, S. M. Davis, G. A. Donnan, M. Lichtenstein, A. E. Baird, D. Binns, P. J. Mitchell, and J. L. Hopper Streptokinase Increases Luxury Perfusion After Stroke Stroke, September 1, 1996; 27(9): 1524 - 1529. [Abstract] [Full Text]
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A. V. Alexandrov, S. E. Black, L. E. Ehrlich, C. F. Bladin, L. T. Smurawska, A. Pirisi, and C. B. Caldwell Simple Visual Analysis of Brain Perfusion on HMPAO SPECT Predicts Early Outcome in Acute Stroke Stroke, September 1, 1996; 27(9): 1537 - 1542. [Abstract] [Full Text]
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A. V. Alexandrov, P. M. Pullicino, E. M. Meslin, and J. W. Norris Agreement on Disease-Specific Criteria for Do-Not-Resuscitate Orders in Acute Stroke Stroke, February 1, 1996; 27(2): 232 - 237. [Abstract] [Full Text]
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D. F. Edwards, Y.-W. Chen MSW, and M. N. Diringer Unified Neurological Stroke Scale Is Valid in Ischemic and Hemorrhagic Stroke Stroke, October 1, 1995; 26(10): 1852 - 1858. [Abstract] [Full Text]
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M. G. Chua, S. M. Davis, B. Infeld, S. C. Rossiter, B. M. Tress, and J. L. Hopper Prediction of Functional Outcome and Tissue Loss in Acute Cortical Infarction Arch Neurol, May 1, 1995; 52(5): 496 - 500. [Abstract] [PDF]
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P. Laloux, F. Richelle, J. Jamart, P. De Coster, and C. Laterre Comparative Correlations of HMPAO SPECT Indices, Neurological Score, and Stroke Subtypes With Clinical Outcome in Acute Carotid Infarcts Stroke, May 1, 1995; 26(5): 816 - 821. [Abstract] [Full Text]
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