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National Institutes of Health (NIH) Stroke Scale; (NIHSS score)
Score Stroke severity
1-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate to severe stroke
21-42 Severe stroke
Procedure:
1) loss of consciousness (LOC)
- alert = 0
- drowsy = 1
- stuporous = 2
- coma = 3
2) LOC questions, orientation (ask month & age)
- both correct = 0
- one correct = 1
- both incorect = 2
3) LOC commands, follows commands (close eyes, make fist)
- both correct = 0
- one correct = 1
- both incorect = 2
4) best gaze
- normal = 0
- partial gaze palsy = 1
- forced (or fixed ?) deviation = 2
5) visual fields
- no visual loss = 0
- partial hemianopia = 1
- complete hemianopia = 2
- bilateral hemianopia = 3
6) facial palsy
- normal = 0
- minor = 1
- partial = 2
- complete = 3
7) motor (left & right arm)*
- no drift = 0
- drift does not hit bed = 1
- drifts down to bed = 2
- no effort against gravity = 3
- no movement = 4
- ampuation/joint fusion = 5
8) motor (left & right legs)*
- no drift = 0
- drift does not hit bed = 1
- drifts down to bed = 2
- no effort against gravity = 3
- no movement = 4
- ampuation/joint fusion = 5
9) limb ataxia
- absent = 0
- present in 1 limb = 1
- present in 2 limbs = 2
10) sensation
- normal = 0
- partial loss = 1
- severe loss = 2
11) best language
- no aphasia = 0
- mild-moderate aphasia = 1
- severe aphasia = 2
- mute = 3
12) dysarthria
- none = 0
- mild-moderate = 1
- near to unintelligible or worse = 2
- intubated or barrier = 3
13) extinction & inattention
- no neglect = 0
- partial neglect = 1
- complete neglect = 2
* motor assessment done with the patient supine;
each limb tested separately
arms brought to 45 degree angle, then released
drift is defined as any change in position after the initial release
Interpretation:
- scoring
a) < 5 = mild neurologic deficit
b) 10-15 = moderate neurologic deficit
c) > 20 = severe neurologic deficit
d) maximum score = 42
General
stroke scale
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18, 19.
American College of Physicians, Philadelphia 2009, 2012, 2018, 2021.
- Wikipedia: National Institutes of Health Stroke Scale
https://en.wikipedia.org/wiki/National_Institutes_of_Health_Stroke_Scale
- National Institutes of Health
http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale_Booklet.pdf