NIH Stroke Scale (NINDS / AHA)

NIHSS — NIH Stroke Scale

Running score: 0 / 42No stroke symptoms
1a Level of consciousness
Examiner observation only — no painful stim needed beyond what differentiates the categories.
1b LOC questions
Ask the current month and the patient's age. Aphasia / intubation that prevents speech scores 2; clear dysarthria can still score 0.
1c LOC commands
Ask to open/close eyes and grip/release the non-paretic hand. Pantomime commands if there is a communication barrier.
2 Best gaze
Only assess horizontal eye movements.
3 Visual fields
Confrontation testing in upper and lower quadrants of each eye.
4 Facial palsy
Ask patient to show teeth, raise eyebrows, close eyes.
5a Motor arm — left
Patient holds left arm extended 90° (sitting) or 45° (supine) for 10 seconds.
5b Motor arm — right
Patient holds right arm extended 90° (sitting) or 45° (supine) for 10 seconds.
6a Motor leg — left
Patient holds left leg at 30° (always supine) for 5 seconds.
6b Motor leg — right
Patient holds right leg at 30° (always supine) for 5 seconds.
7 Limb ataxia
Finger-nose-finger and heel-shin tests on both sides.
8 Sensory
Pinprick on face, arms, trunk, legs — bilateral comparison.
9 Best language
Naming objects + reading + describing the cookie-theft picture.
10 Dysarthria
Articulation only — not aphasia. Have patient read standard list of words.
11 Extinction / inattention
Double simultaneous stimulation (visual + tactile).