NIH Stroke Scale Calculator
Assess stroke severity using the National Institutes of Health Stroke Scale (NIHSS)
NIH Stroke Scale Assessment
1A. Level of Consciousness - Responsiveness
The investigator must choose a response if a full evaluation is prevented by such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages.
1B. Level of Consciousness - Questions
The patient is asked the month and his/her age. The answer must be correct - there is no partial credit for being close.
1C. Level of Consciousness - Commands
The patient is asked to open and close the eyes and then to grip and release the non-paretic hand.
2. Best Gaze
Only horizontal eye movements will be tested. Voluntary or reflexive (oculocephalic) eye movements will be scored.
3. Visual Fields
Visual fields (quadrants) are tested by confrontation, using finger counting or visual threat.
4. Facial Palsy
Ask or use pantomime to encourage the patient to show teeth or raise eyebrows and close eyes.
5A. Motor Arm - Left
The limb is placed in the appropriate position: extend the arms (palms down) 90° (if sitting) or 45° (if supine).
5B. Motor Arm - Right
The limb is placed in the appropriate position: extend the arms (palms down) 90° (if sitting) or 45° (if supine).
6A. Motor Leg - Left
The limb is placed in the appropriate position: hold the leg at 30° (always tested supine).
6B. Motor Leg - Right
The limb is placed in the appropriate position: hold the leg at 30° (always tested supine).
7. Limb Ataxia
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with eyes open.
8. Sensory
Sensation or grimace to pinprick when tested, or withdrawal from noxious stimulus in the obtunded or aphasic patient.
9. Best Language
A great deal of information about comprehension will be obtained during the preceding sections of the examination.
10. Dysarthria
If patient is thought to be normal, an adequate sample of speech must be obtained by asking patient to read or repeat words.
11. Extinction and Inattention (Neglect)
Sufficient information to identify neglect may be obtained during the prior testing.
NIHSS Score Results
Score Interpretation Guide
F.A.S.T. Stroke Signs
Face
Ask the person to smile
Does one side of the face droop?
Arms
Ask person to raise both arms
Does one arm drift downward?
Speech
Ask person to repeat a phrase
Is speech slurred or strange?
Time
Call 911 immediately
Note the time of first symptoms
Clinical Uses
Evaluation of stroke acuity
Treatment determination
Outcome prediction
Neurological status documentation
Patient care planning
Understanding the NIH Stroke Scale
What is the NIHSS?
The National Institutes of Health Stroke Scale (NIHSS) is a standardized assessment tool that objectively quantifies the impairment caused by a stroke. It evaluates neurologic deficits in 11 different domains and provides a reliable measure of stroke severity.
Assessment Domains
- •Level of consciousness
- •Gaze and visual fields
- •Facial palsy
- •Motor function (arms and legs)
- •Limb ataxia and sensory function
- •Language and speech
- •Neglect and inattention
Clinical Significance
Minor Stroke (1-4)
Mild neurological deficit that may require outpatient management or short-term monitoring.
Moderate Stroke (5-15)
Moderate deficit requiring inpatient care and rehabilitation planning.
Severe Stroke (21-42)
Severe deficit requiring intensive care and comprehensive rehabilitation.
Note: The NIHSS takes approximately 5-10 minutes to administer and should be performed by trained healthcare professionals. Serial assessments help track patient improvement or deterioration.