2/10/25, 11:44 AM NIH Stroke Scale UPDATED VERSION 2025 Flashcards | Quizlet
NIH Stroke Scale UPDATED VERSION 2025
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Terms in this set (22)
1a. Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit
for being close. Aphasic and stuporous patients who
do not comprehend the questions will score 2. It is
important that only the initial answer be graded and
that the examiner not "help" the patient with verbal or
How to assess Level of
non-verbal cue.
Consciousness?
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic
hand. If the patient does not respond to command,
the task
should be demonstrated to him or her (pantomime),
and the result scored (i.e., follows none, one or two
commands)
https://quizlet.com/1003841384/nih-stroke-scale-updated-version-2025-flash-cards/?new 1/8
, 2/10/25, 11:44 AM NIH Stroke Scale UPDATED VERSION 2025 Flashcards | Quizlet
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
What are the results? effects or totally unresponsive, flaccid, and areflexic.
0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye movements
will be scored, but caloric testing is not done. If the
How to assess best gaze? patient has a conjugate deviation of the eyes that can
be overcome by voluntary or reflexive activity, the
score will be 1If a patient has an isolated peripheral
nerve paresis (CN III, IV or VI), score a 1
0 = Normal.
1 = Partial gaze palsy; gaze is abnormal in one or both
eyes,
What are the results?
but forced deviation or total gaze paresis is not
present.
2 = Forced deviation, or total gaze
https://quizlet.com/1003841384/nih-stroke-scale-updated-version-2025-flash-cards/?new 2/8
NIH Stroke Scale UPDATED VERSION 2025
Save
Terms in this set (22)
1a. Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit
for being close. Aphasic and stuporous patients who
do not comprehend the questions will score 2. It is
important that only the initial answer be graded and
that the examiner not "help" the patient with verbal or
How to assess Level of
non-verbal cue.
Consciousness?
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic
hand. If the patient does not respond to command,
the task
should be demonstrated to him or her (pantomime),
and the result scored (i.e., follows none, one or two
commands)
https://quizlet.com/1003841384/nih-stroke-scale-updated-version-2025-flash-cards/?new 1/8
, 2/10/25, 11:44 AM NIH Stroke Scale UPDATED VERSION 2025 Flashcards | Quizlet
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
What are the results? effects or totally unresponsive, flaccid, and areflexic.
0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye movements
will be scored, but caloric testing is not done. If the
How to assess best gaze? patient has a conjugate deviation of the eyes that can
be overcome by voluntary or reflexive activity, the
score will be 1If a patient has an isolated peripheral
nerve paresis (CN III, IV or VI), score a 1
0 = Normal.
1 = Partial gaze palsy; gaze is abnormal in one or both
eyes,
What are the results?
but forced deviation or total gaze paresis is not
present.
2 = Forced deviation, or total gaze
https://quizlet.com/1003841384/nih-stroke-scale-updated-version-2025-flash-cards/?new 2/8
