National Institutes of Health (NIH) Stroke Scale

National Institutes of Health (NIH) Stroke Scale

The stroke scale items should be presented in order and the score should be reported after each numbered category has been assessed. The score should be based on the patient’s actual performance and what is witnessed by the examiner. This Stroke Scale is brought to you by

1a. Level of consciousness 0 = Alert and responsive1 = Arousable to minor stimulation

2 = Arousable only to painful stimulation

3 = Unarousable or reflex responses

1b. Questions

Ask patient’s age and month. Must be exact.

0 = Both correct1 = One correct

2 = Neither correct

1c. Commands

Ask patient to open/close eyes, grip and release non-affected hand.

0 = Both correct1 = One correct

2 = Neither correct

2. Best gaze

Horizontal extraocular movements by voluntary or reflexive testing.

0 = Normal1 = Partial gaze palsy; abnormal gaze in one or both eyes

2 = Forced eye deviation or total paresis which cannot be overcome by oculocephalic maneuver

3. Visual fields

Test by confrontation or threat as appropriate. If monocular, score field of good eye.

0 = No visual loss1 = Partial hemianopia, quadrantanopia, extinction

2 = Complete hemianopia

3 = Bilateral hemianopia or blindness

4. Facial palsy

If stuporous, check symmetry of grimace to pain. Paralysis (lower face).

0 = Normal1 = Minor paralysis (normal looking face, asymmetric smile)

2 = Partial paralysis

3 = Complete paralysis (upper and lower face)

5a. Left motor arm

5b. Right motor arm

Arms outstretched 90° (if patient is sitting) or 45° (if supine) for 10 seconds. Encourage best effort, note paretic side.

0 = No drift1 = Drift but does not hit bed

2 = Some antigravity effort, but cannot sustain
3 = No antigravity effort, but minimal movement present

4 = No movement at all X = Unable to assess due to amputation, fusion, etc

6a. Left motor leg

6b. Right motor leg

Raise leg to 30° (always test patient supine) for 5 seconds.

7. Limb ataxia

Check finger-nose-finger; heel-shin; score only if out of proportion to weakness.

0 = No ataxia (or aphasic, hemiplegic)1 = Ataxia present in one limb

2 = Ataxia present in two limbs X = Unable to assess as above

8. Sensory

Use safety pin. Check grimace or withdrawal if stuporous. Score only stroke related losses.

0 = Normal1 = Mild to moderate unilateral sensory loss but patient aware of touch

2 = Severe to total sensory loss, patient unaware of touch (or bilateral sensory loss or comatose)

9. Best language

Ask patient to describe cookie jar picture, name objects, read sentences. May use repeating, writing, stereognosis.

0 = Normal1 = Mild-moderate aphasia

2 = Severe aphasia (almost no information exchanged)
3 = Mute, global aphasia, or coma

10. Dysarthria

Ask patient to read or repeat a list of words.

0 = Normal1 = Mild-moderate dysarthria

2 = Severe, unintelligible or mute

X = Intubation or mechanical barrier

11. Extinction and inattention

Simultaneously touch patient on both hands, show fingers in both visual fields, ask patient to describe deficit, left hand.

0 = Normal, none detected (or severe visual loss with normal cutaneous responses)1 = Neglects or extinguishes to bilateral simultaneous stimulation in any sensory modality (visual, tactile, auditory, spatial, or personal inattention)

2 = Profound hemi-inattention or extinction in more than one modality

stroke scale

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