Canadian Neurological Scale (CNS) Cheat Sheet
Alert or Drowsy → CNS
Stuporous or Comatose → Glasgow Coma Scale
M
E
N
T
A
T
I
O
N
Level of Consciousness
Orientation
Alert 3.0
Drowsy 1.5
Oriented 1.0
Disoriented 0.0
Speech
Receptive deficit 0.0
Expressive deficit 0.5
Normal Speech 1.0
Spontaneous eye opening, normal level of consciousness
When stimulated verbally patient remains awake and alert but tends to doze
1. Where are you? (City and Hospital) 2. What is the month and year?
Speech can be slurred but must be intelligible.
Patient cannot state both place and time or cannot express answers in words or
intelligible speech.
It is acceptable for patient to write answer to questions of orientation
Receptive deficit:

Ask pt. 1) to close eyes; 2) Point to ceiling; 3) Does a stone sink in water?

If pt. does not complete the above 3, go to Section A2.
↓
Section A1
No
Comprehension
Deficit
Face
None 0.5
Present 0.0
Arm: Proximal
None 1.5
Mild 1.0
Significant 0.5
Total 0.0
Arm: Distal
None 1.5
Mild 1.0
Significant 0.5
Total 0.0
Leg: Proximal
None 1.5
Mild 1.0
Significant 0.5
Total 0.0
Leg: Distal
None 1.5
Mild 1.0
Significant 0.5
Total 0.0
Ask pt. to smile:

No weakness – 0.5

Weakness – 0.0 (Record L or R)
Ask pt. to lift arms to shoulder level and apply resistance above elbows
bilaterally

No weakness – 1.5

Movement to 90, unable to oppose pressure – 1.0

Movement < 90 – 0.5

Absence of motion – 0.0
Ask pt. to bend wrist back. Apply pressure on back of the hand.

No weakness – 1.5

Can bend wrist, unable to oppose pressure – 1.0

Some movement of fingers – 0.5

Absence of movement – 0.0
Ask pt. to flex knee to 90. Push down on each thigh one at a time.

No weakness – 1.5

Can lift leg, unable to oppose pressure – 1.0

Lateral movement but no power to lift leg – 0.5

Absence of movement – 0.0
Ask pt. to point toes and feet upward. Push down on each foot one at a time.

No weakness – 1.5

Can point foot & toes upward, unable to oppose pressure – 1.0

Some movement of toes, but cannot lift toes or foot – 0.5

Absence of movement – 0.0
Section A2
Comprehension
Deficit
Face:
Symmetrical 0.5
Asymmetrical 0.0
Arms:
Equal 1.5
Unequal 0.0
Legs:
Equal 1.5
Unequal 0.0
Developed by Moire Brown and Jun Li, HHS
Ask pt. to mimic your grin (if unable, apply pressure to sternum).

Symmetrical – 0.5

Asymmetrical – 0.0
Demonstrate/place pt. arms in front of pt. at 90 (if unable, apply finger nail
bed pressure bilaterally and compare response)

Equal motor response – 1.5

Unequal motor response – 0.0 (record L or R)
Thighs flexed to 90 (if unable, apply toenail bed pressure bilaterally and
compare response)

Maintain position or withdraw equally – 1.5

Cannot maintain position or unequal withdrawing – 0.0 (record L or R)