Pediatric NIH Stroke Scale (NIHSS)
Quantifies stroke severity using a child-specific version of the NIH Stroke Score.
INSTRUCTIONS
Administer the questions in the order below. In order to improve score accuracy, emphasize with family members the need to refrain from hinting at the correct responses to questions asked.
When to Use
Pearls/Pitfalls
Why Use
Alert; keenly responsive
0Not alert but arousable by minor stimulation to obey, answer, or respond
+1Not alert, requires repeated stimulation, or is obtunded and requires strong/painful stimulation to make movements (not stereotyped)
+2Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, areflexic
+3Answers both questions correctly
0Answers one question correctly
+1Answers neither question correctly
+2Performs both tasks correctly
0Performs one task correctly
+1Performs neither task correctly
+2Normal
0Partial gaze palsy (abnormal gaze in one or both eyes but no forced deviation or total gaze paresis)
+1Forced deviation or total gaze paresis not overcome by oculocephalic maneuver
+2No visual loss
0Partial hemianopia
+1Complete hemianopia
+2Bilateral hemianopia (blind including cortical blindness)
+3Normal symmetrical movement
0Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
+1Partial paralysis (total or near total paralysis of lower face)
+2Complete paralysis of one or both sides (absence of facial movement in the upper and lower face)
+3No drift, limb holds 90 (or 45) degrees for full 10 seconds
0Drift, limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support
+1Some 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
+2No effort against gravity, limb falls
+3No movement
+4Amputation, joint fusion
+9No drift, limb holds 90 (or 45) degrees for full 10 seconds
0Drift, limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support
+1Some 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
+2No effort against gravity, limb falls
+3No movement
+4Amputation, joint fusion
+9No drift, leg holds 30 degrees position for full 5 seconds
0Drift, leg falls by the end of the 5 second period but does not hit bed
+1Leg falls to bed by 5 seconds, but has some effort against gravity
+2No effort against gravity, leg falls to bed immediately
+3No movement
+4Amputation, joint fusion
+9No drift, leg holds 30 degrees position for full 5 seconds
0Drift, leg falls by the end of the 5 second period but does not hit bed
+1Leg falls to bed by 5 seconds, but has some effort against gravity
+2No effort against gravity, leg falls to bed immediately
+3No movement
+4Amputation, joint fusion
+9Absent
0Present in one limb
+1Present in two limbs
+2Normal; no sensory loss
0Mild to moderate sensory loss; patient feels pinprick is less sharp or dull on the affected side, or there is a loss of superficial pain with pinprick but patient is aware he/she is being touched
+1Severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg
+2No aphasia, normal
0Mild to moderate aphasia
+1Severe aphasia
+2Mute, global aphasia; no usable speech or auditory comprehension
+3Repetition test:
Reading test:
Fluency test:
Naming test:
Normal
0Mild to moderate; patient slurs at least some words and, at worst, can be understood with some difficulty
+1Severe; 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
+2Intubated or other physical barrier
+9No abnormality
0Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities
+1Profound hemi-inattention or hemi-inattention to >1 modality; does not recognize own hand or orients to only one side of space
+2Result:
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