Monday 24 April 2017

NIH STROKE SCALE

NIH Stroke Scale/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.
BEFORE USE
The NIH Stroke Scale has many caveats buried within it. If your patient has prior known neurologic deficits e.g. prior weakness, hemi- or quadriplegia, blindness, etc. or is intubated, has a language barrier, etc., it becomes especially complicated. In those cases, 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.
Rules:
  • Score what you see, not what you think.
  • Score the first response, not the best response (except Item 9 - Best Language).
  • Don’t coach.
When to Use
Pearls/Pitfalls
Why Use
Alert; keenly responsive
0
Arouses to minor stimulation
+1
Requires repeated stimulation to arouse
+2
Movements to Pain
+2
Postures or unresponsive
+3
Both questions right
0
1 question right
+1
0 questions right
+2
Dysarthric/intubated/trauma/language barrier
+1
Aphasic
+2
Performs both tasks
0
Performs 1 task
+1
Performs 0 tasks
+2
Normal
0
Partial gaze palsy: can be overcome
+1
Partial gaze palsy: corrects with oculocephalic reflex
+1
Forced gaze palsy: cannot be overcome
+2
No visual loss
0
Partial hemianopia
+1
Complete hemianopia
+2
Patient is bilaterally blind
+3
Bilateral hemianopia
+3
Normal symmetry
0
Minor paralysis (flat nasolabial fold, smile asymetry)
+1
Partial paralysis (lower face)
+2
Unilateral complete paralysis (upper/lower face)
+3
Bilateral complete paralysis (upper/lower face)
+3
No drift for 10 seconds
0
Drift, but doesn't hit bed
+1
Drift, hits bed
+2
Some effort against gravity
+2
No effort against gravity
+3
No movement
+4
Amputation/joint fusion
0
No drift for 10 seconds
0
Drift, but doesn't hit bed
+1
Drift, hits bed
+2
Some effort against gravity
+2
No effort against gravity
+3
No movement
+4
Amputation/joint fusion
0
No drift for 10 seconds
0
Drift, but doesn't hit bed
+1
Drift, hits bed
+2
Some effort against gravity
+2
No effort against gravity
+3
No movement
+4
Amputation/joint fusion
0
No drift for 10 seconds
0
Drift, but doesn't hit bed
+1
Drift, hits bed
+2
Some effort against gravity
+2
No effort against gravity
+3
No movement
+4
Amputation/joint fusion
0
No ataxia
0
Ataxia in 1 Limb
+1
Ataxia in 2 Limbs
+2
Does not understand
0
Paralyzed
0
Amputation/joint fusion
0
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
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
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
0
No abnormality
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
About the Creator
Dr. Patrick D. Lyden
Content Contributors
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