NIH Stroke Scale

Aka: NIH Stroke Scale

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II. Precautions

  1. NIH Stroke Scale has imperfect interrater reliability (i.e. different scores by different providers)
  2. NIH Stroke Scale may be low despite severe, disabling symptoms and signs (e.g. Vertigo in posterior CVA)
  3. Facial droop may be subtle
    1. Consider counting visible teeth on each side for comparison
  4. When a patient is too weak overall to perform a particular exam element
    1. Default to a lower score (as if patient could perform that element)
    2. Obviously this does not apply to a focal weakness
  5. References
    1. Swadron and Shoenberger in Herbert (2019) EM:Rap 19(3): 1

III. Criteria

  1. Assess Level of Consciousness (0-3 points)
    1. Alert: 0
    2. Alerts to voice: 1
    3. Alerts to pain: 2
    4. Unresponsive: 3
  2. Assess Orientation (0-2 points)
    1. Current Month (1 point if fails)
    2. Patient's own Age (1 point if fails)
  3. Follow Commands (0-2 points)
    1. Open and close eyes (1 point if fails)
    2. Make fist and release (1 point if fails)
  4. Follow my finger (0-2 points)
    1. Normal: 0
    2. Partial Gaze Palsy: 1
    3. Forced deviation: 2
  5. Visual Field (0-3 points)
    1. No visual loss: 0
    2. Partial Hemianopsia: 1
    3. Complete Hemianopsia: 2
    4. Bilateral Hemianopsia: 3
  6. Facial palsy (0-3 points)
    1. Testing: Show teeth, Raise eyebrows, Squeeze eyes shut
    2. Normal symmetric movements: 0
    3. Minor paralysis: 1
    4. Partial paralysis: 2
    5. Complete paralysis: 3
  7. Motor: Left Arm (0-4 points)
    1. Testing: Elevation limb to 90 degrees for 10 seconds
    2. No drift: 0
    3. Drifts (within 10 seconds): 1
    4. Unable to get to and maintain full limb elevation: 2
    5. Unable to move against gravity (limb falls): 3
    6. No movement: 4
  8. Motor: Right Arm (0-4 points)
    1. Testing: Elevation limb to 90 degrees for 10 seconds
    2. No drift: 0
    3. Drifts (within 10 seconds): 1
    4. Unable to get to and maintain full limb elevation: 2
    5. Unable to move against gravity (limb falls): 3
    6. No movement: 4
  9. Motor: Left Leg (0-4 points)
    1. Testing: Elevation limb to 30 degrees for 5 seconds
    2. No drift: 0
    3. Drifts (within 5 seconds): 1
    4. Unable to get to and maintain full limb elevation: 2
    5. Unable to move against gravity (limb falls): 3
    6. No movement: 4
  10. Motor: Right Leg (0-4 points)
    1. Testing: Elevation limb to 30 degrees for 5 seconds
    2. No drift: 0
    3. Drifts (within 5 seconds): 1
    4. Unable to get to and maintain full limb elevation: 2
    5. Unable to move against gravity (limb falls): 3
    6. No movement: 4
  11. Coordination or limb Ataxia (0-2 points)
    1. Testing: Finger-Nose-Finger, Heel-Knee-Shin
    2. Absent: 0
    3. Present in one limb: 1
    4. Present in both limbs: 2
  12. Sensory (0-2 points)
    1. Test: Pin prick to face, arm, trunk, and legs
    2. Normal: 0
    3. Mild to moderate sensory loss (reduced, dull): 1
    4. Severe or total sensory loss (unaware of touch): 2
  13. Aphasia or Best Language (0-3 points)
    1. Test: Name items, Describe picture, Read sentences
    2. No Aphasia: 0
    3. Mild to moderate Aphasia: 1
    4. Severe Aphasia: 2
    5. Global Aphasia (Mute): 3
  14. Dysarthria (0-2 points)
    1. Normal articulation: 0
    2. Mild to moderate Dysarthria: 1
    3. Severe Dysarthria (nearly unintelligible): 2
    4. Intubated or other physical barrier: N/A
  15. Extinction and Inattention or Neglect (0-2 points)
    1. Testing: Bilateral simultaneous stimulation using one or more sensory modalities (Vision, touch, Hearing)
    2. No abnormality: 0
    3. Inattention or extinction to single sensory modality: 1
    4. Profound inattention or extinction or to multiple sensory modalities: 2

IV. Interpretation

  1. Score 0
    1. No Stroke Symptoms
  2. Score 1-4
    1. Minor Stroke
  3. Score 5-15
    1. Moderate Stroke
  4. Score 16-20
    1. Moderate to Severe Stroke
  5. Score 21-42
    1. Severe Stroke

V. Resources

  1. Stroke-Site
    1. http://www.stroke-site.org

VI. Reference

  1. Spilker (2000) Stroke Intervent 2:7-14
  2. (2000) Circulation 102(suppl I):I-204 to I-216 [PubMed]

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