NIH Stroke Scale 4

NIH Stroke Scale 4 Part 1 (a, b, c) - CORRECT ANSWERS-*LEVEL OF CONSCIOUSNESS* *1a: Arousal* 0 = alert 1 = drowsy; awakens w minor stimulation 2 = obtunded or needs repeated stimulation 3 = reflexive responses only or unresponsive *1b: Questions* = Name and current month, +1 for language barrier 0 = both questions 1 = one 2 = neither question *1c: Commands* = Open and close eyes, grip and release non-paretic hands 0 = both 1 = one 2 = neither Part 2-3 - CORRECT ANSWERS-*EYES* *2: Gaze* 0 = Normal 1 = Gaze deviation that can be overcome (preference) 2 = Forced gaze deviation (palsy) *Isolated palsy = 1 *3: Visual Fields* via confrontation or threat if comatose 1 = partial hemianopia 2 = complete hemianopia 3 = total blindness bilat (cortical blindness) *If pt has unilat blindness, use good eye for fields Part 4 - CORRECT ANSWERS-*FACE* - Ask patient to smile and raise eyebrows. If obtunded, use grimace to pain. 1 = mild asymmetry (nasolabial field flattened) 2 = lower facial droop 3 = complete paralysis of 1 or both sides of face including upper face Part 5-6 - CORRECT ANSWERS-*MOTOR STRENGTH* *5a and b* = *Arm strength* via raise each arm to 45 degrees if supine, 90 degrees if sitting. 0 = no drift 1 = mild drift w/o hitting bed 2 = limb drifts down to bed before 10 secs (arm) or 5 seconds (leg) 3 = no effort against gravity 4 = no movement at all *UN - amputation or joint fusion, document why *6a and 6b = Leg strength* via raise each leg to 30 degrees (supine). 0 = no drift 1 = mild w/o hitting bed 2 = limb drifts down to bed before 10 sec (arm) or 5 sec (leg) 3 = no effort against gravity 4 = no movement at all *UN - amputation or joint fusion, document why Most strokes are _____. Weakness is greater _____ than ______. - CORRECT ANSWERS-*Cortical*, weaker proximally than distally Part 7 - CORRECT ANSWERS-*LIMB ATAXIA* Test finger to nose and heel to shin. Only scored if positive. 0 = absent or patient is comatose or paralyzed 1 = ataxia in one limb 2 = present in both limbs *UN if amputation or joint effusion, explain Part 8 - CORRECT ANSWERS-*SENSORY* Test pinprick w safety pin in all four limbs 0 = normal, no sensory loss 1 = mild-mod sensory loss. Patient usually aware of being touched on hemisensory loss side. 2 = severe or total sensory loss; not aware *Patient who do not have reflexive responses to pain are given a 2 Part 9 - CORRECT ANSWERS-*LANGUAGE* Aphasia: Have patient describe picture and name objects. If can't see, can ask questions and use large objects in room 0 = no aphasia 1 = mild-mod, examiner can understand most of what patient is saying 2 = severe aphasia, examiner can't understand 3 = mute or comatose. *Intubated patient should be asked to write if possible Part 10 - CORRECT ANSWERS-*DYSARTHRIA* Slurred, garbled, or incoherent speech. Have patient read sentences and words. If they cannot read can ask them to repeat "Methodist episcopal" although if aphasic, repetition is difficult. 0 = normal 1 = mild (mostly understood) 2 = severe or mute UN = intubated Part 11 - CORRECT ANSWERS-*EXTINCTION* Extinction/Inattention. Tested in vision and sensory. 0 = no extinction. Only scored if present. 1 = extinction in any sensory modality (visual, tactile, auditory, personal inattention) 2 = more than one modality, profound neglect What two components are "only scored if present", if not, they get 0 - CORRECT ANSWERS-Limb ataxia Extinction NIH means to distinguish between - CORRECT ANSWERS-Large and small strokes Larger strokes are usually greater than ____ on the NIHSS - CORRECT ANSWERS-10 NIHSS is heavily weight towards - CORRECT ANSWERS-Aphasic left hemisphere MCA strokes *Brainstem strokes could have lower score despite being just as serious if not more serious Total score is from 0 to - CORRECT ANSWERS-