Escalas en Neurología - Sociedade Galega de Neuroloxia

13-ESCALAS (263-291) 3/6/08 12:08 Página 273
Escala 83a. CRIBADO DE ICTUS. STROKE SYMPTOM QUIESTIONNAIR (SSQ) DE BERGER
Have you ever had a weakness or paralysis of a complete body side or an arm or leg?
no yes don´t know
If yes: Please briefly describe symptoms and their duration
Were these symptoms treated by a physician?
no yes don´t know
If yes: when and where? _______________________________ 19 _______
month year
____________________________________________________________________________
name and address of treating physician or hospital
Have you ever had a slurred speech or problems to talk to somebody because your mouth was
unable to articulate words or sentences correctly?
Figure A
no yes don´t know
If yes: Please briefly describe duration of the symptom?
________________________________________________________________
Was these symptoms treated by a physician?
no yes don´t know
If yes: when and where? _______________________________ 19 _______
month year
____________________________________________________________________________
name and address of treating physician or hospital
Have you ever had numbness or sensory loss of a complete body side or an arm or leg?
no yes don´t know
If yes: Please briefly describe symptoms and their duration
Were these symptoms treated by a physician?
no yes don´t know
If yes: when and where? _______________________________ 19 _______
month year
____________________________________________________________________________
name and address of treating physician or hospital
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ICTUS
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