NIH Stroke Scale
The NIH stroke scale, also known as the National Institutes of Health Stroke Scale (NIHSS), is a standardized assessment tool used to measure the severity of a stroke. It is used to assess the presence and severity of neurological deficits resulting from a stroke and to monitor the patient's progress over time.
Time to complete
5 minutes
Eligibility
Eligibility for the NIH Stroke Scale includes: - Age 18 years or older - Ability to comprehend and follow commands - Ability to cooperate with the examiner
Questions for NIH Stroke Scale
Level of Consciousness
- Alert; keenly responsive.
- Not alert; but arousable by minor stimulation to obey, answer, or respond.
- Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped).
- Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and areflexic.
LOC Questions
The patient is asked the month and his/her age.
- Answers both questions correctly.
- Answers one question correctly.
- Answers neither question correctly.
LOC Commands
The patient is asked to open and close the eyes and then to grip and release the non-paretic hand.
- Performs both tasks correctly.
- Performs one task correctly.
- Performs neither task correctly.
Best Gaze
Only horizontal eye movements will be tested.
- Normal.
- Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.
- Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver.
Visual
Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or visual threat, as appropriate.
- No visual loss.
- Partial hemianopia
- Complete hemianopia.
- Bilateral hemianopia (blind including cortical blindness).
Facial Palsy
Ask – or use pantomime to encourage – the patient to show teeth or raise eyebrows and close eyes.
- Normal symmetrical movements.
- Minor paralysis (flattened nasolabial fold, asymmetry on smiling).
- Partial paralysis (total or near-total paralysis of lower face).
- Complete paralysis of one or both sides (absence of facial movement in the upper and lower face).
Motor Arm (Right arm)
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine).
- No drift; limb holds 90 (or 45) degrees for full 10 seconds.
- Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.
- Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.
- No effort against gravity; limb falls.
- No movement.
Motor Arm (Left arm)
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine).
- No drift; limb holds 90 (or 45) degrees for full 10 seconds.
- Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.
- Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.
- No effort against gravity; limb falls.
- No movement.
Motor Leg (Right leg)
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine).
- No drift; leg holds 30-degree position for full 5 seconds.
- Drift; leg falls by the end of the 5-second period but does not hit bed.
- Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity.
- No effort against gravity; leg falls to bed immediately.
- No movement.
Motor Leg (Left leg)
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine).
- No drift; leg holds 30-degree position for full 5 seconds.
- Drift; leg falls by the end of the 5-second period but does not hit bed.
- Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity.
- No effort against gravity; leg falls to bed immediately.
- No movement.
Limb Ataxia
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with eyes open.
- Absent.
- Present in one limb.
- Present in two limbs.
Sensory
Sensation or grimace to pinprick when tested.
- Normal; no sensory loss.
- Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched.
- Severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg.
Best Language
For this scale item, the patient is asked to describe what is happening in the attached picture, to name the items on the attached naming sheet and to read from the attached list of sentences.
- No aphasia; normal.
- Mild-to-moderate aphasia.
- Severe aphasia.
- Mute, global aphasia.
Best Language
For this scale item, the patient is asked to describe what is happening in the attached picture, to name the items on the attached naming sheet and to read from the attached list of sentences.
- No aphasia; normal.
- Mild-to-moderate aphasia.
- Severe aphasia.
- Mute, global aphasia.
Dysarthria
If patient is thought to be normal, an adequate sample of speech must be obtained by asking patient to read or repeat words.
- Normal.
- Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty.
- Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.
Extinction and Inattention
Sufficient information to identify neglect may be obtained during the prior testing.
- No abnormality.
- Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities.
- Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space.
Similar Ideas
- Canadian Neurological Scale
- National Institutes of Health Stroke Scale (NIHSS)
- Cincinnati Prehospital Stroke Scale
- Los Angeles Motor Scale
Here are some FAQs and additional information
on NIH Stroke Scale
What is the NIH Stroke Scale?
The NIH Stroke Scale (NIHSS) is a standardized assessment tool used to measure the effects of a stroke. It is used to assess the severity of a stroke, track a patient's progress over time, and inform treatment decisions.
Who developed the NIH Stroke Scale?
The NIH Stroke Scale was developed by the National Institutes of Health (NIH), the largest biomedical research organization in the world.
What does the NIH Stroke Scale measure?
The NIH Stroke Scale measures the effects of a stroke on a person’s physical, cognitive, and language abilities. It assesses the severity of the stroke and can be used to track a patient’s progress over time.
How is the NIH Stroke Scale used?
The NIH Stroke Scale is used by healthcare professionals to assess the severity of a stroke, track a patient’s progress over time, and inform treatment decisions. It is also used in clinical trials to compare the effectiveness of different treatments.
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