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NIH Stroke Scale/Score (NIHSS)

Calculates the NIH Stroke Scale for quantifying stroke severity.

Disclaimer: The NIH Stroke Scale is simply a tool that is used in telemedicine consultations for acute stroke. It requires specialized training and understanding of neurologic evaluation in the setting of acute stroke consultations. The examination may not be accurate assessment of acute neurologic deficit if your patient has prior known neurologic deficits.

1A: Level of Consciousness

1B: Ask Month and Age

1C: 'Blink Eyes' & 'Squeeze Hands'
(Pantomime Commands if Communication Barrier)

2: Test Horizontal Extraocular Movements

3: Test Visual Fields

4: Test Facial Palsy
(Use Grimace if Obtunded)

5A: Test Left Arm Motor Drift

5B: Test Right Arm Motor Drift

6A: Test Left Leg Motor Drift

6B: Test Right Leg Motor Drift

7: Test Limb Ataxia
(FNF/Heel-Shin)

8: Test Sensation

9: Test Language/Aphasia

10: Test Dysarthria

11: Test Extinction/Inattention

References

  • Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, SpilkerJ,Holleran R, Eberle R, Hertzberg V, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989 Jul;20(7):864-70. PubMed PMID: 2749846.
  • Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, Woolson RF, Hansen MD. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999 Jul 13;53(1):126-31. PubMed PMID: 10408548.
  • Appelros P, TerĂ©nt A. Characteristics of the National Institute of Health Stroke Scale: results from a population-based stroke cohort at baseline and after one year. Cerebrovasc Dis. 2004;17(1):21-7. Epub 2003 Oct 3. PubMed PMID: 14530634.
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NIH Stroke Scale