Neurology

NIH Stroke Scale (NIHSS)

Standardized assessment of acute ischemic stroke severity.

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Parameters

1a. Level of Consciousness*

1b. LOC Questions (Month and Age)*

1c. LOC Commands (Open/close eyes, grip/release hand)*

2. Best Gaze (Horizontal eye movements)*

3. Visual (Visual fields by confrontation)*

4. Facial Palsy (Show teeth, raise eyebrows, squeeze eyes)*

5a. Motor Arm - Left (Extend arms 90° or 45° for 10 sec)*

5b. Motor Arm - Right*

6a. Motor Leg - Left (Hold leg at 30° for 5 sec)*

6b. Motor Leg - Right*

7. Limb Ataxia (Finger-nose, heel-shin)*

8. Sensory (Pinprick to face, arm, trunk, leg)*

9. Best Language (Describe picture, name items, read sentences)*

10. Dysarthria*

11. Extinction and Inattention (Neglect)*

NIH Stroke Scale (NIHSS) Result

FormulaSum of 15 parameters assessing consciousness, vision, motor, ataxia, sensation, language, and inattention.

Clinical Pearls

The gold standard clinical tool for rapidly quantifying stroke severity. Used universally to communicate between EMS, ED, and Neurology teams.

Limitations

Biased towards anterior circulation (middle cerebral artery) strokes. Posterior circulation strokes (e.g., cerebellar) may score very low despite severe, disabling symptoms (like intense vertigo and truncal ataxia).