NIH Stroke Scale (NIHSS)
Standardized stroke severity examination.
Inputs
Complete1a. Level of consciousness
1b. LOC questions (month, age)
1c. LOC commands (eyes, grip)
2. Best gaze
3. Visual fields
4. Facial palsy
5a. Left arm
5b. Right arm
6a. Left leg
6b. Right leg
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction and inattention
Worked calculation
Your values are highlighted.
- Points
When to use
- Suspected acute stroke and serial monitoring.
Pearls and pitfalls
- Score what the patient does, not what you think they could do.
- Disabling deficits can occur with low scores (for example, isolated aphasia or hemianopia).
Why use
The universal stroke severity language.
| Criterion | Points |
|---|---|
| 1a. Level of consciousness: Alert | 0 |
| Not alert, arousable by minor stimulation | +1 |
| Not alert, requires repeated stimulation | +2 |
| Unresponsive or reflex responses only | +3 |
| 1b. LOC questions (month, age): Both correct | 0 |
| One correct | +1 |
| Neither correct | +2 |
| 1c. LOC commands (eyes, grip): Both correct | 0 |
| One correct | +1 |
| Neither correct | +2 |
| 2. Best gaze: Normal | 0 |
| Partial gaze palsy | +1 |
| Forced deviation | +2 |
| 3. Visual fields: No visual loss | 0 |
| Partial hemianopia | +1 |
| Complete hemianopia | +2 |
| Bilateral hemianopia or blindness | +3 |
| 4. Facial palsy: Normal | 0 |
| Minor | +1 |
| Partial (lower face) | +2 |
| Complete (upper and lower) | +3 |
| 5a. Left arm: No drift for 10 s | 0 |
| Drift | +1 |
| Some effort against gravity | +2 |
| No effort against gravity | +3 |
| No movement | +4 |
| 5b. Right arm: No drift for 10 s | 0 |
| Drift | +1 |
| Some effort against gravity | +2 |
| No effort against gravity | +3 |
| No movement | +4 |
| 6a. Left leg: No drift for 5 s | 0 |
| Drift | +1 |
| Some effort against gravity | +2 |
| No effort against gravity | +3 |
| No movement | +4 |
| 6b. Right leg: No drift for 5 s | 0 |
| Drift | +1 |
| Some effort against gravity | +2 |
| No effort against gravity | +3 |
| No movement | +4 |
| 7. Limb ataxia: Absent | 0 |
| Present in one limb | +1 |
| Present in two limbs | +2 |
| 8. Sensory: Normal | 0 |
| Mild to moderate loss | +1 |
| Severe or total loss | +2 |
| 9. Best language: No aphasia | 0 |
| Mild to moderate aphasia | +1 |
| Severe aphasia | +2 |
| Mute, global aphasia | +3 |
| 10. Dysarthria: Normal | 0 |
| Mild to moderate | +1 |
| Severe, unintelligible or mute | +2 |
| 11. Extinction and inattention: None | 0 |
| In one modality | +1 |
| Profound or in more than one modality | +2 |