NIH Stroke Scale Score NIHSS Top of Form Note The NIH Stroke by jennyyingdi

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									NIH Stroke Scale/Score (NIHSS)
Note: The NIH Stroke Scale requires that you understand the neurologic exam and has many
caveats buried within it; if your patient has any prior known neurologic deficits (prior
weakness, hemi- or quadriplegia, blindness, etc.), it becomes especially complicated; you
should consult the NIH Stroke Scale website. MDCalc's version is an attempt to clarify many
of these confusing caveats, but cannot be substituted for the official protocol.
1A: Level of
                                   Alert; keenly responsive 0
Consciousness
(If intubated/difficult to assess, Not Alert, but arousable by minor stimulation 1
make best guess, but only
choose 3 if                    Not Alert, requires repeated stimulation to arouse 2
posturing/unresponsive)
                               Not Alert/Obtunded, Makes Movements to Pain 2
                               Postures or Unresponsive to Pain 3
1B: Ask Month and Age
                               Both Questions Right 0
                               Answers 1 Question Right 1
                               Answers 0 Questions Right 2
                               Dysarthric, Intubated, Trauma, Language Barrier 1
                               Aphasic 2
1C: Tell Patient To Open
and Close Eyes, then           Performs Both Tasks Correctly 0
Hand Grip Squeeze
(Substitute/Pantomime
                               Performs One Task Correctly 1
Commands if Language           Performs 0 Tasks Correctly 2
Barrier/Confusion)
2: Test Horizontal
                               Normal Extraocular Movements 0
Extraocular Movements
                               Partial Gaze Palsy: Can Be Overcome 1
                               Partial Gaze Palsy: Corrects with Oculocephalic Reflex 1
                               Forced Gaze Palsy: Cannot Be Overcome 2
3: Test Visual Fields
                               No Visual Loss 0
                               Partial Hemianopia 1
                               Complete Hemianopia 2
                               Patient is Bilaterally Blind 3
                               Bilateral Hemianopia 3
4: Test Facial Palsy
(Use Grimace if Obtunded)
                               Normal symmetrical movements 0
                               Minor paralysis (flat nasolabial fold, smile asymetry) 1
                               Partial paralysis (total/near-total lower face paralysis) 2
                               Unilateral Complete paralysis (no facial movement
                            upper/lower face) 3
                               Bilateral Complete paralysis (no facial movement upper/lower
                           face) 3
5A: Test Left Arm Motor
                               No Drift for 10 Seconds 0
Drift
                               Drift, but does not hit bed/support 1
                               Drift, but hits bed/support 2
                               Some Anti-Gravity Effort 2
                               No Effort Against Gravity 3
                               No Movement 4
                               Amputation/Joint Fusion Unable
5B: Test Right Arm
                               No Drift for 10 Seconds 0
Motor Drift
                               Drift, but does not hit bed/support 1
                               Drift, but hits bed/support 2
                               Some Anti-Gravity Effort 2
                               No Effort Against Gravity 3
                               No Movement 4
                               Amputation/Joint Fusion Unable
6A: Test Left Leg Motor
                               No Drift for 5 Seconds 0
Drift
                               Drift, but does not hit bed 1
                               Drift, but hits bed/support 2
                               Some Anti-Gravity Effort 2
                               No Effort Against Gravity 3
                               No Movement 4
                               Amputation/Joint Fusion Unable
6B: Test Right Leg Motor
                               No Drift for 5 Seconds 0
Drift
                               Drift, but does not hit bed 1
                               Drift, but hits bed/support 2
                               Some Anti-Gravity Effort 2
                               No Effort Against Gravity 3
                               No Movement 4
                               Amputation/Joint Fusion Unable
7: Test Limb Ataxia
                               No Ataxia 0
(FNF/Heel-Shin)
                               Ataxia in 1 Limb 1
                               Ataxia in 2 Limbs 2
                               Does Not Understand 0
                               Paralyzed 0
                                    Amputation/Joint Fusion Unable
8: Test Sensation
                                    Normal; No sensory loss 0
                                    Mild-Moderate Loss: Less Sharp/More Dull 1
                                    Mild-Moderate Loss: Can Sense Being Touched 1
                                    Complete Loss: Cannot Sense Being Touched At All 2
                                    No Response and Quadriplegic 2
                                    Coma/Unresponsive 2
9: Test Language/Aphasia
(Describe the scene; name the
                                    Normal; No aphasia 0
words; read the sentences.)         Mild-Moderate Aphasia: Some Obvious Changes, Without
                                Significant Limitation 1
                                   Severe Aphasia: Fragmentary Expression, Inference Needed,
                                Cannot Identify Materials 2
                                   Mute/Global Aphasia: No Usable Speech/Auditory
                                Comprehension 3
                                    Coma/Unresponsive 3
10: Test Dysarthria
(Read the words.)
                                    Normal 0
                                    Mild-Moderate Dysarthria: Slurring but can be understood 1
                                    Severe Dysarthria: Unintelligble Slurring or Out of Proportion
                                to Dysphasia 2
                                    Mute/Anarthric 2
                                    Intubated/Unable to Test UN
11: Test
                                    No abnormailty 0
Extinction/Inattention
                                    Visual/tactile/auditory/spatial/personal inattention 1
                                    Extinction to bilateral simultaneous stimulation 1
                                    Profound hemi-inattention (ex: does not recognize own hand) 2
                                    Extinction to >1 modality 2
NIH Stroke Scale:                Click!

Remember, an NIH Stroke Scale of 0 does not mean the patient is not having a stroke!
(Notorious for missing posterior circulation strokes.)

								
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