NIH Stroke Scale (NIHSS)

Quantifies stroke severity and monitors for neurological changes over time.

NIHSS (NIH Stroke Scale) Calculator

A systematic assessment tool to quantify neurological deficit in patients with acute stroke.

1a. Level of Consciousness:

0 – Alert 1 – Not alert, but arousable to minor stimulation 2 – Not alert, requires repeated stimulation to attend, or requires strong/painful stimulation to make movements (not stereotyped) 3 – Responds only with reflex motor or autonomic effects, or totally unresponsive

1b. LOC Questions (What month is it? What is your age?):

0 – Answers both correctly 1 – Answers one correctly 2 – Answers neither correctly

1c. LOC Commands (Open and close eyes. Make a fist, open your hand.):

0 – Performs both correctly 1 – Performs one correctly 2 – Performs neither correctly

2. Best Gaze:

0 – Normal 1 – Partial gaze palsy; gaze abnormality in one or both eyes 2 – Forced deviation; oculocephalic maneuver fails to overcome deviation

3. Visual Fields:

0 – No visual loss 1 – Partial hemianopia 2 – Complete hemianopia 3 – Bilateral hemianopia (blindness)

4. Facial Palsy:

0 – Normal symmetrical movements 1 – Minor paralysis (nasolabial fold flattening, asymmetry on smiling) 2 – Partial paralysis (complete paralysis of lower face) 3 – Complete paralysis (upper and lower face paralysis)

5. Motor Arm (record score for each limb):

Left Arm:

0 – No drift 1 – Drift, no fall to bed 2 – Some effort against gravity 3 – No effort against gravity 4 – No movement 9 – Amputation/Joint fusion

Right Arm:

0 – No drift 1 – Drift, no fall to bed 2 – Some effort against gravity 3 – No effort against gravity 4 – No movement 9 – Amputation/Joint fusion

6. Motor Leg (record score for each limb):

Left Leg:

0 – No drift 1 – Drift, no fall to bed 2 – Some effort against gravity 3 – No effort against gravity 4 – No movement 9 – Amputation/Joint fusion

Right Leg:

0 – No drift 1 – Drift, no fall to bed 2 – Some effort against gravity 3 – No effort against gravity 4 – No movement 9 – Amputation/Joint fusion

7. Limb Ataxia (Finger-Nose-Finger, Heel-Shin):

0 – Absent 1 – Present in one limb 2 – Present in two limbs 9 – Untestable

8. Sensory (pinprick or light touch):

0 – Normal 1 – Mild-to-moderate sensory loss 2 – Severe-to-total sensory loss

9. Best Language (Describe picture, name items, read sentences):

0 – No aphasia 1 – Mild-to-moderate aphasia 2 – Severe aphasia (little spontaneous speech) 3 – Mute, global aphasia

10. Dysarthria:

0 – Normal articulation 1 – Mild-to-moderate dysarthria 2 – Severe dysarthria (unintelligible) 9 – Intubated/Other physical barrier

11. Extinction and Inattention (Neglect):

0 – No neglect 1 – Visual, tactile, auditory, spatial, or personal inattention to one side 2 – Profound hemi-inattention or extinction to more than one modality