NIH Stroke Scale: Difference between revisions

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'''1a. Level of consciousness'''
==Background==
 
*Intubation or limb pathology making categories not testable should be considered and potentially not scored.
Alert = 0<br>
*tPA candidate generally with NIHSS 4 - 22


Not alert, arousable to mild stimulation = 1
==Scale==
===Level of Consciousness===
====1a General====
*Alert = 0<br>
*Not alert, arousable to mild stimulation = 1  
*Not alert, arousable to significant stimulation = 2
*Not alert; reflexic, autonomic or no response = 3


Not alert, arousable to significant stimulation = 2
====1b. Questions====
*Month and DOB
**Both correct = 0
**One correct = 1
**Zero correct = 2  


Not alert; reflexic, autonomic or no response = 3
====1c. Commands====
*Open/close eyes &amp; squeeze/release hand:
**Both correct = 0
**One correct = 1
**Zero correct = 2


'''1b. Level of Consc. Questions:''' Month and DOB
===2. Best Gaze===
*Horizontal voluntary or oculocephalic reflex:
**Normal = 0
**Partial gaze palsy = 1
**Forced deviation or total gaze palsy = 2


Both correct = 0
===3. Visual Fields===
*Normal = 0  
*Partial hemianopia = 1
*Complete hemianopia = 2
*Bilateral hemianopia or cortical blindness = 3


One correct = 1
===4. Facial Paralysis===
*Normal = 0
*Minor, flat nasolabial fold = 1  
*Partial or total uni lower paralysis= 2
*Complete paralysis 1 or both sides (upper &amp; lower) = 3


Zero correct = 2
===5. Motor Arm===
*10 seconds:
**No drift = 0
**Some drift = 1
**Falls, effort against gravity = 2  
**Falls, No effort against gravity = 3
**No movement = 4


'''1c. Level of Consc. Command:''' Open/close eyes &amp; squeeze/release hand
===6. Motor Leg===
*5 seconds:
**No drift = 0
**Some drift = 1
**Falls, effort against gravity = 2
**Falls, No effort against gravity = 3
**No movement = 4


Both correct = 0
===7. Limb ataxia===
*Absent = 0  
*One limb = 1
*Two limb = 2


One correct = 1
===8. Sensory Loss===
*Arms, legs, trunk:
**Normal = 0
**Present but altered = 1  
**Absent = 2


Zero correct = 2
===9. Best Language===
*Identification (picture or tactile), repetition, comprehension:
**No aphasia = 0
**Mild to moderate = 1
**Severe = 2  
**Mute/Global aphasia = 3


'''2. Best Gaze:''' Horizontal voluntary or oculocephalic reflex
===10. Dysarthria===
*None = 0
*Mild to moderate = 1
*Severe = 2  


Normal = 0
===11. Extinction/Inattention===
*Neglect:
**None = 0  
**Loss of 1 modality (visual, tactile, auditory, spatial, personal) = 1
**Profound hemi-inattention or more than 1 modality = 2
[[File:NIHSS pictures and words.gif|thumb|Language/aphasia and Dysarthria]]


Partial gaze palsy = 1
==External Links==
*[http://www.mdcalc.com/modified-nih-stroke-scale-score-mnihss/ MDCalc - NIH Stroke Scale/Score]


Forced deviation or total gaze palsy = 2
{{NIHSS Calculator}}


'''3. Visual Fields'''
==References==
 
<references/>
Normal = 0
National Institute of Neurologic Disorders and Stroke
 
Partial hemianopia = 1
 
Complete hemianopia = 2
 
Bilateral hemianopia or cortical blindness = 3
 
'''4. Facial Paralysis'''
 
Normal = 0
 
Minor, flat nasolabial fold = 1
 
Partial or total uni lower paralysis= 2
 
Complete paralysis 1 or both sides (upper &amp; lower) = 3
 
'''5. Motor Arm''' (10 seconds)
 
No drift = 0
 
Some drift = 1
 
Falls, effort against gravity = 2
 
Falls, No effort against gravity = 3
 
No movement = 4
 
'''6. Motor Leg''' (5 seconds)
 
No drift = 0
 
Some drift = 1
 
Falls, effort against gravity = 2
 
Falls, No effort against gravity = 3
 
No movement = 4
 
'''7. Limb ataxia'''
 
Absent = 0
 
One limb = 1
 
Two limb = 2
 
'''8. Sensory Loss''' (arms, legs, trunk)
 
Normal = 0
 
Present but altered = 1
 
Absent = 2
 
'''9. Best Language:''' identification (picture or tactile), repetition, comprehension
 
No aphasia = 0
 
Mild to moderate = 1
 
Severe = 2
 
Mute/Global aphasia =3
 
'''10. Dysarthria'''
 
None = 0
 
Mild to moderate = 1
 
Severe = 2
 
1'''1. Extinction/Inattention '''(neglect)
 
None = 0
 
Loss of 1 modality (visual, tactile, auditory, spatial, personal) = 1
 
Profound hemi-inattention or more than 1 modality = 2
 
*Intubation or limb pathology making categories not testable should be considered and potentially not scored.
 
*tPA candidate generally with NIHSS 4 - 22


Source: National Institute of Neurologic Disorders and Stroke
==See Also==
*[[CVA (Main)]] for VAN score
*[[Thrombolysis_in_Acute_Ischemic_Stroke_(tPA)|tPA in Stroke]]


Fink 04/06/2012
[[Category:Neurology]]

Latest revision as of 00:52, 25 March 2026

Background

  • Intubation or limb pathology making categories not testable should be considered and potentially not scored.
  • tPA candidate generally with NIHSS 4 - 22

Scale

Level of Consciousness

1a General

  • Alert = 0
  • Not alert, arousable to mild stimulation = 1
  • Not alert, arousable to significant stimulation = 2
  • Not alert; reflexic, autonomic or no response = 3

1b. Questions

  • Month and DOB
    • Both correct = 0
    • One correct = 1
    • Zero correct = 2

1c. Commands

  • Open/close eyes & squeeze/release hand:
    • Both correct = 0
    • One correct = 1
    • Zero correct = 2

2. Best Gaze

  • Horizontal voluntary or oculocephalic reflex:
    • Normal = 0
    • Partial gaze palsy = 1
    • Forced deviation or total gaze palsy = 2

3. Visual Fields

  • Normal = 0
  • Partial hemianopia = 1
  • Complete hemianopia = 2
  • Bilateral hemianopia or cortical blindness = 3

4. Facial Paralysis

  • Normal = 0
  • Minor, flat nasolabial fold = 1
  • Partial or total uni lower paralysis= 2
  • Complete paralysis 1 or both sides (upper & lower) = 3

5. Motor Arm

  • 10 seconds:
    • No drift = 0
    • Some drift = 1
    • Falls, effort against gravity = 2
    • Falls, No effort against gravity = 3
    • No movement = 4

6. Motor Leg

  • 5 seconds:
    • No drift = 0
    • Some drift = 1
    • Falls, effort against gravity = 2
    • Falls, No effort against gravity = 3
    • No movement = 4

7. Limb ataxia

  • Absent = 0
  • One limb = 1
  • Two limb = 2

8. Sensory Loss

  • Arms, legs, trunk:
    • Normal = 0
    • Present but altered = 1
    • Absent = 2

9. Best Language

  • Identification (picture or tactile), repetition, comprehension:
    • No aphasia = 0
    • Mild to moderate = 1
    • Severe = 2
    • Mute/Global aphasia = 3

10. Dysarthria

  • None = 0
  • Mild to moderate = 1
  • Severe = 2

11. Extinction/Inattention

  • Neglect:
    • None = 0
    • Loss of 1 modality (visual, tactile, auditory, spatial, personal) = 1
    • Profound hemi-inattention or more than 1 modality = 2
Language/aphasia and Dysarthria

External Links


NIH Stroke Scale (NIHSS)

NIH Stroke Scale (NIHSS)
Category Select Score
1a. Level of Consciousness 1 Alert (0)   Not alert, arousable (1)   Not alert, obtunded (2)   Unresponsive (3)
1b. LOC Questions (month, age) 1 Both correct (0)   One correct (1)   Neither correct (2)
1c. LOC Commands (open/close eyes, grip/release) 1 Both correct (0)   One correct (1)   Neither correct (2)
2. Best Gaze (horizontal) 1 Normal (0)   Partial gaze palsy (1)   Forced deviation (2)
3. Visual (visual fields) 1 No visual loss (0)   Partial hemianopia (1)   Complete hemianopia (2)   Bilateral hemianopia (3)
4. Facial Palsy 1 Normal (0)   Minor paralysis (1)   Partial paralysis (2)   Complete paralysis (3)
5a. Motor Arm — Left (drift) 1 No drift (0)   Drift (1)   Some effort against gravity (2)   No effort against gravity (3)   No movement (4)
5b. Motor Arm — Right 1 No drift (0)   Drift (1)   Some effort against gravity (2)   No effort against gravity (3)   No movement (4)
6a. Motor Leg — Left 1 No drift (0)   Drift (1)   Some effort against gravity (2)   No effort against gravity (3)   No movement (4)
6b. Motor Leg — Right 1 No drift (0)   Drift (1)   Some effort against gravity (2)   No effort against gravity (3)   No movement (4)
7. Limb Ataxia 1 Absent (0)   Present in one limb (1)   Present in two limbs (2)
8. Sensory 1 Normal (0)   Mild-moderate loss (1)   Severe/total loss (2)
9. Best Language 1 No aphasia (0)   Mild-moderate aphasia (1)   Severe aphasia (2)   Mute/global aphasia (3)
10. Dysarthria 1 Normal (0)   Mild-moderate (1)   Severe/mute (2)
11. Extinction/Inattention 1 No abnormality (0)   Inattention to one modality (1)   Profound neglect (2)
NIHSS Total / 42
Interpretation
0 No stroke symptoms.
1–4 Minor stroke.
5–15 Moderate stroke.
16–20 Moderate-severe stroke.
21–42 Severe stroke.
References
  • Brott T, Adams HP Jr, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870. PMID 2749846.
  • Lyden P, et al. NIHSS Training and Certification Using a Reliable Web-Based Tool. Stroke. 2009;40(8):2507-2511.
  • Note: NIHSS ≥6 is commonly used threshold for thrombolytic eligibility consideration.

References

National Institute of Neurologic Disorders and Stroke

See Also

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