What is the National Institutes of Health Stroke Scale (NIHSS)?

Updated: Dec 03, 2018
  • Author: Ashish Nanda, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Answer

The National Institutes of Health Stroke Scale (NIHSS) (see Table 1 below) is used mostly by stroke teams for quantifying neurologic impairment. It enables rapid determination of the severity and possible location of the stroke. A patient’s score on the NIHSS is strongly associated with outcome, and it can help identify those patients who are likely to benefit from thrombolytic therapy and those who are at higher risk for developing hemorrhagic complications of thrombolytic use.

Table 1. National Institutes of Health Stroke Scale (Open Table in a new window)

 

Category

Score - Description

1a

level of consciousness (LOC)

0 Alert

1 Drowsy

2 Stuporous

3 Coma

1b

LOC questions (month, age)

0 Answers both correctly

1 Answers 1 correctly

2 Incorrect on both

1c

LOC commands (open and close eyes, grip and release nonparetic hand)

0 Obeys both correctly

1 Obeys 1 correctly

2 Incorrect on both

2

Best gaze (follow finger)

0 Normal

1 Partial gaze palsy

2 Forced deviation

3

Best visual (visual fields)

0 No visual loss

1 Partial hemianopia

2 Complete hemianopia

3 Bilateral hemianopia

4

Facial palsy (show teeth, raise brows, squeeze eyes shut)

0 Normal

1 Minor

2 Partial

3 Complete

5

Motor arm left* (raise 90°, hold 10 seconds)

0 No drift

1 Drift

2 Cannot resist gravity

3 No effort against gravity

4 No movement

6

Motor arm right* (raise 90°, hold 10 seconds)

0 No drift

1 Drift

2 Cannot resist gravity

3 No effort against gravity

4 No movement

7

Motor leg left* (raise 30°, hold 5 seconds)

0 No drift

1 Drift

2 Cannot resist gravity

3 No effort against gravity

4 No movement

8

Motor leg right* (raise 30°, hold 5 seconds)

0 No drift

1 Drift

2 Cannot resist gravity

3 No effort against gravity

4 No movement

9

Limb ataxia (finger-nose, heel-shin)

0 Absent

1 Present in 1 limb

2 Present in 2 limbs

10

Sensory (pinprick to face, arm, leg)

0 Normal

1 Partial loss

2 Severe loss

11

Extinction/neglect (double simultaneous testing)

0 No neglect

1 Partial neglect

2 Complete neglect

12

Dysarthria (speech clarity to “mama, baseball, huckleberry, tip-top, fifty-fifty”)

0 Normal articulation

1 Mild to moderate dysarthria

2 Near to unintelligible or worse

13

Best language** (name items, describe pictures)

0 No aphasia

1 Mild to moderate aphasia

2 Severe aphasia

3 Mute

 

Total

0-42

* For limbs with amputation, joint fusion, etc, score 9 and explain.

** For intubation or other physical barriers to speech, score 9 and explain. Do not add 9 to the total score


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