Hemorrhagic stroke NIH stroke scale

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

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National Institutes of Health Stroke Scale

The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0.

Score	Stroke severity
0	No stroke symptoms
1-4	Minor stroke
5-15	Moderate stroke
16-20	Moderate to severe stroke
21-42	Severe stroke

The National Institutes of Health Stroke Scale has been repeatedly validated as a tool for assessing stroke severity and as an excellent predictor for patient outcomes. Severity of a stroke is heavily correlated with the volume of brain affected by the stroke, strokes effecting larger portions of the brain tend to have more detrimental effects. NIHSS scores have been found to be reliable predictors of damaged brain volume, with a smaller NIHSS score indicating a smaller lesion volume

Item	Scoring Definitions
Level of consciousness (LOC) Responsiveness	0 = alert and responsive 1 = arousable to minor stimulation 2 = arousable only to painful stimulation 3 = reflex responses or unarousable
LOC Questions (patient's age and month)	0 = both correct 1 = one correct (or dysarthria, intubated, foreign language) 2 = neither correct
LOC Commands (open/close eyes and then grip/release hand)	0 = both correct (acceptable if impaired by weakness) 1 = one correct 2 = neither correct
Horizontal Eye Movement (voluntary or doll's eye maneuver)	0 = normal 1 = partial gaze palsy; abnormal gaze in one or both eyes 2 = forced eye deviation or total paresis that cannot be overcome by doll's eye maneuver
Visual field (each eye is tested individually)	0 = no visual loss 1 = partial hemianopsia, quadrantanopia, extinction 2 = complete hemianopsia 3 = bilateral hemianopsia or blindness
Facial palsy (in stuporous, check symmetry of grimace to pain)	0 = normal 1 = minor paralysis, flat NLF, asymmetrical smile 2 = partial paralysis (lower face = UMN lesion) 3 = complete paralysis (upper and lower face)
Motor arm (arms outstretched for 10 seconds)	0 = no drift for 10 seconds 1 = drift but does not hit bed 2 = some antigravity effort, but cannot sustain 3 = no antigravity effort, but even minimal movement counts 4 = no movement at all X = unable to assess owing to amputation, fusion, fracture, and so on
Motor leg (raise leg for 5 seconds)	0 = no drift for 5 seconds 1 = drift but does not hit bed 2 = some antigravity effort, but cannot sustain 3 = no antigravity effort, but even minimal movement counts 4 = no movement at all X = unable to assess owing to amputation, fusion, fracture, and so on
Limb ataxia (check finger-nose-finger, heel-shin position sense/score only if out of proportion to paralysis)	0 = no ataxia (or aphasic, hemiplegic) 1 = ataxia in upper or lower extremity 2 = ataxia in upper and lower extremity X = unable to assess owing to amputation, fusion, fracture, and so on
Sensory (check grimace or withdrawal if patient is stuporous)	0 = normal 1 = mild-moderate unilateral loss but patient aware of touch (or aphasic, confused) 2 = total loss, patient unaware of touch; coma, bilateral loss
Best language (describe the scenario in the figure, name objects, read sentences)	0 = normal 1 = mild-moderate aphasia (speech difficult to understand but partly comprehensible) 2 = severe aphasia (almost no information exchanged) 3 = mute, global aphasia, coma; no one-step commands
Dysarthria (read list of words)	0 = normal 1 = mild-moderate; slurred but intelligible 2 = severe; unintelligible or mute X = intubation or mechanical barrier
Extinction or neglect (simultaneously touch patient on both hands/show fingers in both visual fields)	0 = normal, none detected (visual loss alone) 1 = neglects or extinguishes to double simultaneous stimulation in any modality (visual, auditory, sensation, spatial, body parts) 2 = profound neglect in more than one modality

References

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