Escalas en Neurología - Sociedade Galega de Neuroloxia

13-ESCALAS (263-291) 3/6/08 12:08 Página 274
J. DÍAZ GUZMÁN
Escala 83a. STROKE SYMPTOM QUIESTIONNAIR (SSQ) DE BERGER (Cont.)
Have you ever had one or more of visual symptoms shown in figure B on one or both eyes?
no yes don´t know
If yes: Please mark all symptoms that occured and briefly describe symptoms and their duration
Were these symptoms treated by a physician?
Figure B
no yes don´t know
If yes: when and where? _______________________________ 19 _______
month year
____________________________________________________________________________
name and address of treating physician or hospital
Two images
(Diplopia)
Have you ever been diagnosed with stroke by a physician?
no yes don´t know
If yes: Please briefly describe symptoms and their duration
Were these symptoms treated by a physician?
Loss of central vision Three images
Loss of vision
at the top
no yes don´t know
If yes: when and where? _______________________________ 19 _______
month year
____________________________________________________________________________
name and address of treating physician or hospital
� 274 �
Loss of vision
to one side