Detailed NIH Stroke Scale
1a. Level of Consciousness:
0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey, answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and areflexic.
Score: ***
1b. LOC Questions: The patient is asked the month and his/her age.
0= Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly.
Score:
1c. LOC Commands: The patient is asked to open/close the eyes, and then to grip/release the hand.
0= Performs both tasks correctly.
1= Performs one task correctly.
2= Performs neither task correctly.
Score: ***
2. Gaze: Test horizontal eye movements.
0 = Normal.
1 = Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.
2 = Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver.
Score: ***
3. Visual field testing
0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
Score: ***
4. Facial Palsy
0 = Normal symmetrical movements.
1 = Minor paralysis (flattened nasolabial fold, asymmetry on smiling).
2 = Partial paralysis (total or near-total paralysis of lower face).
3 = Complete paralysis of one or both sides (absence of facial movement in the upper and lower face).
Score: ***
5a Motor left arm
0 = No drift; limb holds 90 (or 45) degrees for full 10 seconds.
1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.
2 = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.
3 = No effort against gravity; limb falls.
4 = No movement.
Score: ***
5b Motor right arm
0 = No drift; limb holds 90 (or 45) degrees for full 10 seconds.
1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.
2 = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.
3 = No effort against gravity; limb falls.
4 = No movement.
Score: ***
6a Motor left leg
0 = No drift; leg holds 30-degree position for full 5 seconds.
1 = Drift; leg falls by the end of the 5-second period but does not hit bed.
2 = Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity.
3 = No effort against gravity; leg falls to bed immediately.
4 = No movement.
Score: ***
6b Motor right leg
0 = No drift; leg holds 30-degree position for full 5 seconds.
1 = Drift; leg falls by the end of the 5-second period but does not hit bed.
2 = Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity.
3 = No effort against gravity; leg falls to bed immediately.
4 = No movement.
Score: ***
7. Limb ataxia: Test finger-nose, and heel-shin
0 = Absent.
1 = Present in one limb.
2 = Present in two limbs.
Score: ***
8. Sensory loss
0 = Normal; no sensory loss.
1 = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched.
2 = Severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg.
Score: ***
9. Language
0 = No aphasia
1 = Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension,
2 = Severe aphasia; all communication is through fragmentary expression
3 = Mute, global aphasia
Score: ***
10. Speech
0 = Normal.
1 = Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty.
2 = Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.
Score: ***
11. Neglect
0 = No abnormality.
1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities.
2 = Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space.
Score: ***
Total NIH Stroke Scale: ***