Homonymous hemianopsia due to posterior ischemia as a model for quantification of neurologic deficit.

Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1,000 words (typed double-spaced) in length and may be subject to editing or abridgment. Descriptions of the natural history of brain infarction and evaluation of therapeutic interventions rely on definitions of the degree of handicap and neurologic deficit of the patients. The Barthel index is the best known of the functional evaluation systems since it is the easiest to perform. The index describes basically the degree of independence from nursing care or other medical help. The maximum score of 100 reflects a high degree of independence, but not freedom from symptoms, since handicaps related to speech impediments are not included in the evaluation. At the lower end of the scale, improvement in the patient's condition is not reflected in a higher score. Therefore, the Barthel index is not suitable for an evaluation of subtle therapeutic effects despite a close correlation with the neurologic score up to the level of relative autonomy at a score of approximately 60 points. 1 The Mathew scale is closely related to the degree of neurologic deficit. Points are assigned to different symptoms and signs, with a maximum score of 100 points. However, the large number and variety of parameters evaluated must be accommodated in a few crude categories, and evaluation is ultimately subjective. As a result, a study with four independent observers demonstrated agreement beyond the level of chance for only eight of 13 symptoms. 2 Modification according to Orgogozo and Dartigues 3 eliminates categories with reproducibility of <75%. The Mathew scale does not consider visual field defects or sensory loss, so that findings must be regarded as grossly simplified.