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
