NIH Stroke Scale (NIHSS)
Level of consciousness
Alert, keenly responsive
Arousable by minor stimulation to obey, answer, or respond
Requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped)
Responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid, and areflexic
Ask month and age
Answers both questions correctly
Answers one question correctly
Answers neither question correctly
1C: 'Blink eyes' and 'squeeze hands' tasks
Performs both tasks correctly
Performs one task correctly
Performs neither task correctly
Horizontal extraocular movements
Normal
Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present
Forced deviation, or total gaze paresis is not overcome by the oculocephalic maneuver
Visual fields
No visual loss
Partial hemianopia
Complete hemianopia
Bilateral hemianopia (blind including cortical blindness)
Facial palsy
Normal symmetry
Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
Partial paralysis (total or near-total paralysis of lower face)
Complete paralysis of one or both sides (absence of facial movement in the upper and lower face)
Left arm motor drift
No drift; limb holds 90 (or 45) degrees for full 10 seconds
Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support
Some 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
No effort against gravity; limb falls
No movement
Amputation/joint fusion
Right arm motor drift
No drift; limb holds 90 (or 45) degrees for full 10 seconds
Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support
Some 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
No effort against gravity; limb falls
No movement
Amputation/joint fusion
Left leg motor drift
No drift; leg holds 30-degree position for full 5 seconds
Drift; leg falls by the end of the 5- second period but does not hit the bed
Some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity
No effort against gravity; leg falls to bed immediately
No movement
Amputation/joint fusion
Right leg motor drift
No drift; leg holds 30-degree position for full 5 seconds
Drift; leg falls by the end of the 5- second period but does not hit the bed
Some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity
No effort against gravity; leg falls to bed immediately
No movement
Amputation/joint fusion
7: Limb ataxia
Absent
Ataxia in one limb
Ataxia in two limbs
Amputation/joint fusion
Sensation
Normal
Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched
Severe or total sensory loss; patient is not aware of being touched in the face, arm, and leg
Language/aphasia
Normal
Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression (reduction of speech and/or comprehension, however, makes conversation about provided materials difficult or impossible; for example, in conversation about provided materials, examiner can identify picture or naming card content from patient's response)
Severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener (range of information that can be exchanged is limited; listener carries burden of communication; examiner cannot identify materials provided from patient response)
Mute, global aphasia; no usable speech or auditory comprehension
Dysarthria
Normal
Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty
Severe dysarthria; 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
Intubated/unable to test
Extinction/inattention
No abnormality
Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities
Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space
Please complete all sections.
Reference
P Lyden, T Brott, B Tilley et al. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke. 1994 Nov;25(11):2220-6.
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