National Institutes of Health (NIH) Stroke Scale; (NIHSS score)

Introduction

Table

Score

Procedure

• loss of consciousness (LOC)
  • alert = 0
  • drowsy = 1
  • stuporous = 2
  • coma = 3
• LOC questions, orientation (ask month & age)
  • both correct = 0
  • one correct = 1
  • both incorect = 2
• LOC commands, follows commands (close eyes, make fist)
  • both correct = 0
  • one correct = 1
  • both incorect = 2
• best gaze
  • normal = 0
  • partial gaze palsy = 1
  • forced (or fixed ?) deviation = 2
• visual fields
  • no visual loss = 0
  • partial hemianopia = 1
  • complete hemianopia = 2
  • bilateral hemianopia = 3
• facial palsy
  • normal = 0
  • minor = 1
  • partial = 2
  • complete = 3
• motor (left & right arm)*
  • no drift = 0
  • drift does not hit bed = 1
  • drifts down to bed = 2
  • no effort against gravity = 3
  • no movement = 4
  • ampuation/joint fusion = 5
• motor (left & right legs)*
  • no drift = 0
  • drift does not hit bed = 1
  • drifts down to bed = 2
  • no effort against gravity = 3
  • no movement = 4
  • ampuation/joint fusion = 5
• limb ataxia
  • absent = 0
  • present in 1 limb = 1
  • present in 2 limbs = 2
• sensation
  • normal = 0
  • partial loss = 1
  • severe loss = 2
• best language
  • no aphasia = 0
  • mild-moderate aphasia = 1
  • severe aphasia = 2
  • mute = 3
• dysarthria
  • none = 0
  • mild-moderate = 1
  • near to unintelligible or worse = 2
  • intubated or barrier = 3
• extinction & inattention
  • no neglect = 0
  • partial neglect = 1
  • complete neglect = 2

* motor assessment done with the patient supine;

each limb tested separately

arms brought to 45 degree angle, then released

drift is defined as any change in position after the initial release

Interpretation

• scoring
  • < 5 = mild neurologic deficit
  • 10-15 = moderate neurologic deficit
  • > 20 = severe neurologic deficit
  • maximum score = 42

More general terms

• stroke scale