ToolsCalculators
NIH Stroke Scale (NIHSS)
Quantifies neurological deficit severity in acute ischaemic stroke.
NIH Stroke Scale (NIHSS)
1a. Level of consciousness
1b. LOC questions (month, age)
1c. LOC commands (open/close eyes, grip/release)
2. Best gaze
3. Visual fields
4. Facial palsy
5a. Motor — left arm
5b. Motor — right arm
6a. Motor — left leg
6b. Motor — right leg
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction / inattention
Result0 points
No stroke symptoms. Range 0–42; higher scores indicate greater deficit.
When to use
- Standardised assessment of stroke severity at presentation and serially thereafter.
- Informing reperfusion decisions and prognosis in acute ischaemic stroke.
Formula
Sum of 15 examination items (LOC, gaze, fields, facial palsy, limb motor, ataxia, sensory, language, dysarthria, neglect). Range 0–42.
Pearls and pitfalls
- Higher scores predict larger infarct volume and worse outcome; scores >20 carry high haemorrhage risk with thrombolysis.
- Score in a fixed order and do not go back to change scores; grade what the patient does, not what you think they can do.