The Cincinnati Stroke Scale (CSS) is a simple, rapid assessment tool used primarily by emergency responders to identify potential stroke victims before they reach the hospital. This tool focuses on three physical indicators that frequently appear when a person experiences a stroke. Its primary purpose is to quickly screen for the most common neurological deficits, as the effectiveness of acute stroke treatments depends heavily on time. The CSS provides a structure for non-specialists to recognize these signs.
Step-by-Step Guide to the Assessment
The assessment begins by checking for facial weakness. The examiner instructs the patient to show their teeth or smile widely, observing the movement of both sides of the face simultaneously. The goal is to see if the patient can move both sides of their mouth and eyes symmetrically.
Next, the arm drift component assesses motor strength in the upper extremities. The examiner instructs the patient to close their eyes and hold both arms straight out in front, palms facing upward. The patient must attempt to maintain this position for approximately ten seconds without assistance. This test isolates the motor control required, making subtle weakness apparent.
The final component evaluates the patient’s language and speech clarity. The assessor asks the person to repeat a simple, standard phrase. The examiner must listen carefully for any abnormalities in the patient’s articulation or word choice. This helps determine if the parts of the brain controlling language and speech production have been impaired.
Understanding Positive Indicators
A positive finding occurs when any one of the three tests shows an abnormal result. For the facial droop test, an abnormality is noted if one side of the face moves less than the other, or not at all, resulting in a visible droop when the patient attempts to smile. This asymmetry indicates a potential disruption in the nerve signals controlling the facial muscles.
In the arm drift test, a positive indicator is recorded if one arm drifts downward compared to the other, or if the patient cannot lift the arm to the required position. Even a slight, slow drift or failure to maintain the position for ten seconds is considered a sign of hemiparesis (one-sided weakness).
The speech component is positive if the patient’s speech is slurred, garbled, or incomprehensible (dysarthria). It is also a positive sign if the patient uses inappropriate or incorrect words, or is completely unable to speak (aphasia). If any single component of the CSS yields an abnormal result, the patient is likely experiencing an acute stroke.
Time-Sensitive Emergency Response
A positive result on the Cincinnati Stroke Scale necessitates immediate action, as acute stroke care operates under the principle that “time is brain.” For every minute an ischemic stroke goes untreated, an estimated 1.9 million brain cells are destroyed. Emergency medical services (EMS) must be called without delay to ensure the patient is transported to a specialized stroke center.
The most important information to convey to emergency personnel is the “last known well” time. This is the exact time the patient was last seen acting and feeling completely normal before symptoms began. This time stamp determines a patient’s eligibility for time-sensitive treatments, such as intravenous tissue plasminogen activator (tPA), which dissolves clots and must be administered within a narrow window.
Avoid driving the patient to the hospital personally, as this delays the specialized care that begins the moment EMS is contacted. Emergency medical teams alert the receiving hospital while en route, activating the stroke team. This ensures the patient bypasses the typical emergency room queue for immediate brain imaging and assessment. Expedited evaluation and treatment are linked to better patient outcomes and reduced long-term disability.