NIH Stroke Scale/Score (NIHSS) | TeleSpecialists, LLC

Product Name

NIH Stroke Scale/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.

Disclaimer: The NIH Stroke Scale is simply a tool that is used in telemedicine consultations for acute stroke. It requires specialized training and understanding of neurologic evaluation in the setting of acute stroke consultations. The examination may not be accurate assessment of acute neurologic deficit if your patient has prior known neurologic deficits.

Total

0

points
NIH Stroke Scale

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

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

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

5B: Test Right Arm Motor Drift

6A: Test Left Leg Motor Drift

6B: Test Right Leg Motor Drift

7: Test Limb Ataxia

(FNF/Heel-Shin)

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

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

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 abnormality 0
Visual/tactile/auditory/spatial/personal inattention (+1)
Extinction to bilateral simultaneous stimulation (+1)
Profound hemi-inattention (ex: does not recognize own hand) (+2)

Assessments

1A: Level of Consciousness - Alert; keenly responsive 0

1A: Level of Consciousness - Arouses to minor stimulation +1

1A: Level of Consciousness - Requires repeated stimulation to arouse +2

1A: Level of Consciousness - Movements to Pain +2

1A: Level of Consciousness - Postures or Unresponsive +3

1B: Ask Month and Age - Both Questions Right 0

1B: Ask Month and Age - 1 Question Right +1

1B: Ask Month and Age - 0 Questions Right +2

1B: Ask Month and Age - Dysarthric/Intubated/ Trauma/Language Barrier +1

1B: Ask Month and Age - Aphasic +2

1C: 'Blink Eyes' & 'Squeeze Hands' - Performs Both Tasks 0

1C: 'Blink Eyes' & 'Squeeze Hands' - Performs 1 Task +1

1C: 'Blink Eyes' & 'Squeeze Hands' - Performs 0 Tasks +2

2: Test Horizontal Extraocular Movements - Normal 0

2: Test Horizontal Extraocular Movements - Partial Gaze Palsy: Can Be Overcome +1

2: Test Horizontal Extraocular Movements - Partial Gaze Palsy: Corrects with Oculocephalic Reflex +1

2: Test Horizontal Extraocular Movements - Forced Gaze Palsy: Cannot Be Overcome +2

3: Test Visual Fields - No Visual Loss 0

3: Test Visual Fields - Partial Hemianopia +1

3: Test Visual Fields - Complete Hemianopia +2

3: Test Visual Fields - Patient is Bilaterally Blind +3

3: Test Visual Fields - Bilateral Hemianopia +3

4: Test Facial Palsy - Normal symmetry 0

4: Test Facial Palsy - Minor paralysis (flat nasolabial fold, smile asymetry) +1

4: Test Facial Palsy - Partial paralysis (lower face) +2

4: Test Facial Palsy - Unilateral Complete paralysis (upper/lower face) +3

4: Test Facial Palsy - Bilateral Complete paralysis (upper/lower face) +3

5A: Test Left Arm Motor Drift - No Drift for 10 Seconds 0

5A: Test Left Arm Motor Drift - Drift, but doesn't hit bed +1

5A: Test Left Arm Motor Drift - Drift, hits bed +2

5A: Test Left Arm Motor Drift - Some Effort Against Gravity +2

5A: Test Left Arm Motor Drift - No Effort Against Gravity +3

5A: Test Left Arm Motor Drift - No Movement +4

5A: Test Left Arm Motor Drift - Amputation/Joint Fusion 0

5B: Test Right Arm Motor Drift - No Drift for 10 Seconds 0

5B: Test Right Arm Motor Drift - Drift, but doesn't hit bed +1

5B: Test Right Arm Motor Drift - Drift, hits bed +2

5B: Test Right Arm Motor Drift - Some Effort Against Gravity +2

5B: Test Right Arm Motor Drift - No Effort Against Gravity +3

5B: Test Right Arm Motor Drift - No Movement +4

5B: Test Right Arm Motor Drift - Amputation/Joint Fusion 0

6A: Test Left Leg Motor Drift - No Drift for 5 Seconds 0

6A: Test Left Leg Motor Drift - Drift, but doesn't hit bed +1

6A: Test Left Leg Motor Drift - Drift, hits bed +2

6A: Test Left Leg Motor Drift - Some Effort Against Gravity +2

6A: Test Left Leg Motor Drift - No Effort Against Gravity +3

6A: Test Left Leg Motor Drift - No Movement +4

6A: Test Left Leg Motor Drift - Amputation/Joint Fusion 0

6B: Test Right Leg Motor Drift - No Drift for 5 Seconds 0

6B: Test Right Leg Motor Drift - Drift, but doesn't hit bed +1

6B: Test Right Leg Motor Drift - Drift, hits bed +2

6B: Test Right Leg Motor Drift - Some Effort Against Gravity +2

6B: Test Right Leg Motor Drift - No Effort Against Gravity +3

6B: Test Right Leg Motor Drift - No Movement +4

6B: Test Right Leg Motor Drift - Amputation/Joint Fusion 0

7: Test Limb Ataxia - No Ataxia 0

7: Test Limb Ataxia - Ataxia in 1 Limb +1

7: Test Limb Ataxia - Ataxia in 2 Limbs +2

7: Test Limb Ataxia - Does Not Understand 0

7: Test Limb Ataxia - Paralyzed 0

7: Test Limb Ataxia - Amputation/Joint Fusion 0

8: Test Sensation - Normal; No sensory loss 0

8: Test Sensation - Mild-Moderate Loss: Less Sharp/More Dull +1

8: Test Sensation - Mild-Moderate Loss: Can Sense Being Touched +1

8: Test Sensation - Complete Loss: Cannot Sense Being Touched At All +2

8: Test Sensation - No Response and Quadriplegic +2

8: Test Sensation - Coma/Unresponsive +2

9: Test Language/Aphasia - Normal; No aphasia 0

9: Test Language/Aphasia - Mild-Moderate Aphasia: Some Obvious Changes, Without Significant Limitation +1

9: Test Language/Aphasia - Severe Aphasia: Fragmentary Expression, Inference Needed, Cannot Identify Materials +2

9: Test Language/Aphasia - Mute/Global Aphasia: No Usable Speech/Auditory Comprehension +3

9: Test Language/Aphasia - Coma/Unresponsive +3

10: Test Dysarthria - Normal 0

10: Test Dysarthria - Mild-Moderate Dysarthria: Slurring but can be understood +1

10: Test Dysarthria - Severe Dysarthria: Unintelligble Slurring or Out of Proportion to Dysphasia +2

10: Test Dysarthria - Mute/Anarthric +2

10: Test Dysarthria - Intubated/Unable to Test 0

11: Test Extinction/Inattention - No abnormality 0

11: Test Extinction/Inattention - Visual/tactile/auditory/spatial/personal inattention +1

11: Test Extinction/Inattention - Extinction to bilateral simultaneous stimulation +1

11: Test Extinction/Inattention - Profound hemi-inattention (ex: does not recognize own hand) +2

References

Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, SpilkerJ,Holleran R, Eberle R, Hertzberg V, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989 Jul;20(7):864-70. PubMed PMID: 2749846.
Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, Woolson RF, Hansen MD. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999 Jul 13;53(1):126-31. PubMed PMID: 10408548.
Appelros P, Terént A. Characteristics of the National Institute of Health Stroke Scale: results from a population-based stroke cohort at baseline and after one year. Cerebrovasc Dis. 2004;17(1):21-7. Epub 2003 Oct 3. PubMed PMID: 14530634.