MDCalc Mobile | NIH Stroke Scale/Score (NIHSS)

1A: Level of Consciousness
(If intubated/difficult to assess, make best guess, but only choose 3 if posturing/unresponsive)

Alert; keenly responsive 0
Not Alert, but arousable by minor stimulation 1
Not Alert, requires repeated stimulation to arouse 2
Not Alert/Obtunded, Makes Movements to Pain 2
Postures or Unresponsive to Pain 3

1B: Ask Month and Age

Both Questions Right 0
Answers 1 Question Right 1
Answers 0 Questions Right 2
Dysarthric, Intubated, Trauma, Language Barrier 1
Aphasic 2

1C: Tell Patient To Open and Close Eyes, then Hand Grip Squeeze
(Substitute/Pantomime Commands if Language Barrier/Confusion)

Performs Both Tasks Correctly 0
Performs One Task Correctly 1
Performs 0 Tasks Correctly 2

2: Test Horizontal Extraocular Movements

Normal Extraocular Movements 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 symmetrical movements 0
Minor paralysis (flat nasolabial fold, smile asymetry) 1
Partial paralysis (total/near-total lower face paralysis) 2
Unilateral Complete paralysis (no facial movement upper/lower face) 3
Bilateral Complete paralysis (no facial movement upper/lower face) 3

5A: Test Left Arm Motor Drift

No Drift for 10 Seconds 0
Drift, but does not hit bed/support 1
Drift, but hits bed/support 2
Some Anti-Gravity Effort 2
No Effort Against Gravity 3
No Movement 4
Amputation/Joint Fusion Unable

5B: Test Right Arm Motor Drift

No Drift for 10 Seconds 0
Drift, but does not hit bed/support 1
Drift, but hits bed/support 2
Some Anti-Gravity Effort 2
No Effort Against Gravity 3
No Movement 4
Amputation/Joint Fusion Unable

6A: Test Left Leg Motor Drift

No Drift for 5 Seconds 0
Drift, but does not hit bed 1
Drift, but hits bed/support 2
Some Anti-Gravity Effort 2
No Effort Against Gravity 3
No Movement 4
Amputation/Joint Fusion Unable

6B: Test Right Leg Motor Drift

No Drift for 5 Seconds 0
Drift, but does not hit bed 1
Drift, but hits bed/support 2
Some Anti-Gravity Effort 2
No Effort Against Gravity 3
No Movement 4
Amputation/Joint Fusion Unable

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 Unable

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 UN

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

Note: The NIH Stroke Scale requires that you understand the neurologic exam and has many caveats buried within it; if your patient has any prior known neurologic deficits (prior weakness, hemi- or quadriplegia, blindness, etc.), it becomes especially complicated; you should consult the NIH Stroke Scale website. MDCalc's version is an attempt to clarify many of these confusing caveats, but cannot and should not be substituted for the official protocol.
1A: Level of Consciousness (If intubated/difficult to assess, make best guess, but only choose 3 if posturing/unresponsive)	Alert; keenly responsive 0 Not Alert, but arousable by minor stimulation 1 Not Alert, requires repeated stimulation to arouse 2 Not Alert/Obtunded, Makes Movements to Pain 2 Postures or Unresponsive to Pain 3
1B: Ask Month and Age	Both Questions Right 0 Answers 1 Question Right 1 Answers 0 Questions Right 2 Dysarthric, Intubated, Trauma, Language Barrier 1 Aphasic 2
1C: Tell Patient To Open and Close Eyes, then Hand Grip Squeeze (Substitute/Pantomime Commands if Language Barrier/Confusion)	Performs Both Tasks Correctly 0 Performs One Task Correctly 1 Performs 0 Tasks Correctly 2
2: Test Horizontal Extraocular Movements	Normal Extraocular Movements 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 symmetrical movements 0 Minor paralysis (flat nasolabial fold, smile asymetry) 1 Partial paralysis (total/near-total lower face paralysis) 2 Unilateral Complete paralysis (no facial movement upper/lower face) 3 Bilateral Complete paralysis (no facial movement upper/lower face) 3
5A: Test Left Arm Motor Drift	No Drift for 10 Seconds 0 Drift, but does not hit bed/support 1 Drift, but hits bed/support 2 Some Anti-Gravity Effort 2 No Effort Against Gravity 3 No Movement 4 Amputation/Joint Fusion Unable
5B: Test Right Arm Motor Drift	No Drift for 10 Seconds 0 Drift, but does not hit bed/support 1 Drift, but hits bed/support 2 Some Anti-Gravity Effort 2 No Effort Against Gravity 3 No Movement 4 Amputation/Joint Fusion Unable
6A: Test Left Leg Motor Drift	No Drift for 5 Seconds 0 Drift, but does not hit bed 1 Drift, but hits bed/support 2 Some Anti-Gravity Effort 2 No Effort Against Gravity 3 No Movement 4 Amputation/Joint Fusion Unable
6B: Test Right Leg Motor Drift	No Drift for 5 Seconds 0 Drift, but does not hit bed 1 Drift, but hits bed/support 2 Some Anti-Gravity Effort 2 No Effort Against Gravity 3 No Movement 4 Amputation/Joint Fusion Unable
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 Unable
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 UN
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:
Remember, an NIH Stroke Scale of 0 does not mean the patient is not having a stroke! (Notorious for missing posterior circulation strokes.)

NIH Stroke Scale/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.