NIH Stroke Scale/Score (NIHSS) Clinical Calculator and Pathway

1A: Level of Consciousness Alert; keenly responsive

0

Arouses to minor stimulation

+1

Requires repeated stimulation to arouse

+2

Movements to Pain

+2

Postures or Unresponsive

+3

1B: Ask Month and Age Both Questions Right

0

1 Question Right

+1

0 Questions Right

+2

Dysarthric/Intubated/ Trauma/Language Barrier

+1

Aphasic

+2

1C: 'Blink Eyes' & 'Squeeze Hands' (Pantomime Commands if Communication Barrier) Performs Both Tasks

0

Performs 1 Task

+1

Performs 0 Tasks

+2

2: Test Horizontal Extraocular Movements Normal

0

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 symmetry

0

Minor paralysis (flat nasolabial fold, smile asymetry)

+1

Partial paralysis (lower face)

+2

Unilateral Complete paralysis (upper/lower face)

+3

Bilateral Complete paralysis (upper/lower face

+3

5A: Test Left Arm Motor Drift No Drift for 10 Seconds

0

Drift, but doesn't hit bed

+1

Drift, hits bed

+2

Some Effort Against Gravity

+2

No Effort Against Gravity

+3

No Movement

+4

Amputation/Joint Fusion

0

5B: Test Right Arm Motor Drift No Drift for 10 Seconds

0

Drift, but doesn't hit bed

+1

Drift, hits bed

+2

Some Effort Against Gravity

+2

No Effort Against Gravity

+3

No Movement

+4

Amputation/Joint Fusion

0

6A: Test Left Leg Motor Drift No Drift for 10 Seconds

0

Drift, but doesn't hit bed

+1

Drift, hits bed

+2

Some Effort Against Gravity

+2

No Effort Against Gravity

+3

No Movement

+4

Amputation/Joint Fusion

0

6B: Test Right Leg Motor Drift No Drift for 10 Seconds

0

Drift, but doesn't hit bed

+1

Drift, hits bed

+2

Some Effort Against Gravity

+2

No Effort Against Gravity

+3

No Movement

+4

Amputation/Joint Fusion

0

7: Test Limb Ataxia (FNF/Heel-Shin) No Ataxia

0

Ataxia in 1 Limb

+1

Ataxia in 2 Limbs

+2

Does Not Understand

0

Paralyzed

0

Amputation/Joint Fusion

0

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 words; read the sentences.

Normal; No aphasia

0

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

0

11: Test Extinction/Inattention No abnormailty

0

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/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.

Interpretation