Klinische evaluatie leptomeningeale metastasen

Domain 

Level of Function Score 

Key Considerations

0 

1 

2 

3 

Normal 

Abnormal but walks without assistance

Abnormal and requires assistance (companion, cane, walker, et cetera)

Unable to walk 

1. Walking is ideally assessed by at least 10 steps.

Strength 

Normal 

Movement present but decreased against resistance 

Movement present but none against resistance 

No movement 

1. Each limb should be tested separately.
2. Recommend assess proximal (above knee or elbow) and distal (below knee or elbow) major muscle groups.
3. Score should reflect worst performing area.
4. Patients with preexisting level 3 function in one major muscle group/limb at baseline can be scored based on assessment of other major muscle groups/limb.

Sensation 

Normal 

Decreased but aware of sensory modality 

Unaware of sensory modality 

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1. Recommend evaluating major body areas separately (face, limbs, and trunk).
2. Score should reflect worst performing area.
3. Sensory modality includes but is not limited to light touch, pinprick, temperature, and proprioception.
4. Patients with preexisting level 2 function in one major body area at baseline can be scored based on assessment of other major body areas. 

Vision 

Normal 

Partial monocular visual loss 

Complete monocular visual loss 

Bilateral visual loss 

1. Patients who require corrective lenses should be evaluated while wearing corrective lenses.
2. Each eye should be evaluated, and score should reflect worst performing eye. 

Eye movements 

Normal 

Abnormality noted in 1 direction of gaze 

Abnormality noted in more than 1 gaze direction, but not all 

Unable to move the eye in any gaze direction 

1. Test eye movements for each eye individually.
2. The score will reflect the worst performing eye (ie, the highest score). 

Facial strength 

Normal 

Mild facial weakness (nasolabial fold flattening, asymmetric smile, decreased forehead contraction, or partial eye closure) 

Severe facial weakness (severe nasolabial fold flattening, asymmetric smile with limited or no movement of face, incomplete eye closure, or labial incompetence 

Bilateral facial weakness 

1 Weakness includes nasolabial fold flattening, asymmetric smile, and difficulty elevating eyebrow. 

Hearing 

Normal 

Impaired but residual serviceable hearing 

Absent unilateral hearing 

Bilateral hearing loss 

1. Each ear should be evaluated and score should reflect worst performing ear. 

Swallowing 

Normal 

Impaired but not requiring change in diet formulation, not aspirating by bedside testing 

Unable to swallow without risk of aspiration by bedside testing 

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1. Bedside testing comprising a swallow test with a small glass of water. 

Level of consciousness 

Normal 

Drowsy (easily arousable & responsive) 

Somnolent (difficult to arouse & poorly responsive) 

Coma (unarousable & unresponsive) 

Behavior 

Normal 

Mild/moderate alteration 

Severe alteration 

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1. Alteration includes but is not limited to apathy, disinhibition, and confusion.
3. Consider subclinical seizures for significant alteration. 

Other 

Normal 

Occasional or mild 

Persistent, moderate to severe 

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