NIH STROKE SCALE ACTUAL CLEAN VERSION 2025-2026 LATEST UPDATED
EXAM | VERIIED FOR ACCURACY | SURE PASS
Subject ID ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Subject Date of Birth ___ ___/___ ___/___ ___
Hospital ID _________________________________
Date of Examination ___ ___/___ ___/___ ___
NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS)1
Interval: [ ] Baseline
[ ] 7-10 days
[ ] 1 month
[ ] 3 months
[ ] 6 months
[ ] Other ______________________________________
Time: ___ ___:___ ___ [ ]am [ ]pm
Person Administering Scale _____________________________________
Purpose:
The NIH Stroke Scale (NIHSS) is a standardized neurological examination intended to describe the neurological deficits
found in large groups of stroke patients participating in treatment trials.
Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do
not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the
patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the
exam and work quickly. Except where indicated, the patient should not be coached (i.e., repeated requests to patient to
make a special effort).
Instructions Scale Definition Score
1a. Level of Consciousness: The investigator must
choose a response if a full evaluation is prevented by 0 = Alert; Keenly responsive.
such obstacles as an endotracheal tube language barrier,
orotracheal trauma/bandages. A 3 is scored only if the 1 = Not alert, but arousable by minor stimulation to
patient makes no movement (other than reflexive obey, answer or respond. ____________
posturing) in response to noxious stimulation.
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.
1b. LOC Questions: The patient is asked the month and
his/her age. 0 = Answers both questions correctly.
The answer must be correct – there is no partial credit for
1 The National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health (NIH), Last Revised 01 October
2003 (https://stroke.nih.gov/resources/index.htm).
, NIH STROKE SCALE ACTUAL CLEAN VERSION 2025-2026 LATEST UPDATED
EXAM | VERIIED FOR ACCURACY | SURE PASS
being close. Aphasic and stuporous patients who do not
comprehend the questions will score 2. Patients unable 1 = Answers one question correctly. ____________
to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language 2 = Answers neither question correctly.
barrier, or any other problem not secondary to aphasia
are given a 1. It is important that only the initial answer
be graded and that the examiner not “help” the patient
with verbal or non-verbal cues.
Instructions Scale Definition Score
1c. LOC Commands: The patient is asked to open and
close the eyes and then to grip and release the non- 0 = Answers both tasks correctly.
paretic hand. Substitute another one step command
if the hands cannot be used. Credit is given if an 1 = Answers one task correctly. ____________
unequivocal attempt is made but not completed due
to weakness. If the patient does not respond to 2 = Answers neither task correctly.
command, the task should be demonstrated to
him/her (pantomime), and the result scored (i.e.,
follows none, one or two commands). Patients with
trauma, amputation, or other physical impediments
should be given suitable one-step commands. Only
the first attempt is scored.
2. Best Gaze: Only horizontal eye movements will be
tested. Voluntary or reflexive (oculocephalic) eye 0 = Normal.
movements will be scored, but caloric testing is not
done. If the patient has a conjugate deviation of the 1 = Partial gaze palsy; gaze is abnormal in one or both
eyes that can be overcome by voluntary or reflexive eyes, but forced deviation or total gaze paresis is not ____________
activity, the score will be 1. If a patient has an present.
isolated peripheral nerve paresis (CN III, IV or VI),
score a 1. Gaze is testable in all aphasic patients. 2 = Forced deviation, or total gaze paresis not
Patients with ocular trauma, bandages, pre-existing overcome by the oculocephalic maneuver.
blindness, or other disorder of visual acuity or fields
should be tested with reflexive movements, and a
choice made by the investigator. Establishing eye
contact and then moving about the patient from side
to side will occasionally clarify the presence of a
partial gaze palsy.
3. Visual: Visual fields (upper and lower quadrants)
are tested by confrontation, using finger counting or 0 = No visual loss.
visual threat, as appropriate. Patients may be
encouraged, but if they look at the side of the moving 1 = Partial hemianopia. ____________
fingers appropriately, this can be scored as normal.
If there is unilateral blindness or enucleation, visual 2 = Complete hemianopia.
fields in the remaining eye are scored. Score 1 only
if a clear-cut asymmetry, including quadrantanopia, is
3 = Bilateral hemianopia (blind including cortical
found. If patient is blind from any cause, score 3.
blindness).
Double simultaneous stimulation is performed at this
point. If there is extinction, patient receives a 1, and
the results are used to respond to item 11.
4. Facial Palsy: Ask – or use pantomime to encourage
– the patient to show teeth or raise eyebrows and 0 = Normal symmetrical movements.
close eyes. Score symmetry of grimace in response
to noxious stimuli in the poorly responsive or 1 = Minor paralysis (flattened nasolabial fold,
noncomprehending patient. If facial asymmetry on smiling). ____________
EXAM | VERIIED FOR ACCURACY | SURE PASS
Subject ID ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Subject Date of Birth ___ ___/___ ___/___ ___
Hospital ID _________________________________
Date of Examination ___ ___/___ ___/___ ___
NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS)1
Interval: [ ] Baseline
[ ] 7-10 days
[ ] 1 month
[ ] 3 months
[ ] 6 months
[ ] Other ______________________________________
Time: ___ ___:___ ___ [ ]am [ ]pm
Person Administering Scale _____________________________________
Purpose:
The NIH Stroke Scale (NIHSS) is a standardized neurological examination intended to describe the neurological deficits
found in large groups of stroke patients participating in treatment trials.
Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do
not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the
patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the
exam and work quickly. Except where indicated, the patient should not be coached (i.e., repeated requests to patient to
make a special effort).
Instructions Scale Definition Score
1a. Level of Consciousness: The investigator must
choose a response if a full evaluation is prevented by 0 = Alert; Keenly responsive.
such obstacles as an endotracheal tube language barrier,
orotracheal trauma/bandages. A 3 is scored only if the 1 = Not alert, but arousable by minor stimulation to
patient makes no movement (other than reflexive obey, answer or respond. ____________
posturing) in response to noxious stimulation.
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.
1b. LOC Questions: The patient is asked the month and
his/her age. 0 = Answers both questions correctly.
The answer must be correct – there is no partial credit for
1 The National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health (NIH), Last Revised 01 October
2003 (https://stroke.nih.gov/resources/index.htm).
, NIH STROKE SCALE ACTUAL CLEAN VERSION 2025-2026 LATEST UPDATED
EXAM | VERIIED FOR ACCURACY | SURE PASS
being close. Aphasic and stuporous patients who do not
comprehend the questions will score 2. Patients unable 1 = Answers one question correctly. ____________
to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language 2 = Answers neither question correctly.
barrier, or any other problem not secondary to aphasia
are given a 1. It is important that only the initial answer
be graded and that the examiner not “help” the patient
with verbal or non-verbal cues.
Instructions Scale Definition Score
1c. LOC Commands: The patient is asked to open and
close the eyes and then to grip and release the non- 0 = Answers both tasks correctly.
paretic hand. Substitute another one step command
if the hands cannot be used. Credit is given if an 1 = Answers one task correctly. ____________
unequivocal attempt is made but not completed due
to weakness. If the patient does not respond to 2 = Answers neither task correctly.
command, the task should be demonstrated to
him/her (pantomime), and the result scored (i.e.,
follows none, one or two commands). Patients with
trauma, amputation, or other physical impediments
should be given suitable one-step commands. Only
the first attempt is scored.
2. Best Gaze: Only horizontal eye movements will be
tested. Voluntary or reflexive (oculocephalic) eye 0 = Normal.
movements will be scored, but caloric testing is not
done. If the patient has a conjugate deviation of the 1 = Partial gaze palsy; gaze is abnormal in one or both
eyes that can be overcome by voluntary or reflexive eyes, but forced deviation or total gaze paresis is not ____________
activity, the score will be 1. If a patient has an present.
isolated peripheral nerve paresis (CN III, IV or VI),
score a 1. Gaze is testable in all aphasic patients. 2 = Forced deviation, or total gaze paresis not
Patients with ocular trauma, bandages, pre-existing overcome by the oculocephalic maneuver.
blindness, or other disorder of visual acuity or fields
should be tested with reflexive movements, and a
choice made by the investigator. Establishing eye
contact and then moving about the patient from side
to side will occasionally clarify the presence of a
partial gaze palsy.
3. Visual: Visual fields (upper and lower quadrants)
are tested by confrontation, using finger counting or 0 = No visual loss.
visual threat, as appropriate. Patients may be
encouraged, but if they look at the side of the moving 1 = Partial hemianopia. ____________
fingers appropriately, this can be scored as normal.
If there is unilateral blindness or enucleation, visual 2 = Complete hemianopia.
fields in the remaining eye are scored. Score 1 only
if a clear-cut asymmetry, including quadrantanopia, is
3 = Bilateral hemianopia (blind including cortical
found. If patient is blind from any cause, score 3.
blindness).
Double simultaneous stimulation is performed at this
point. If there is extinction, patient receives a 1, and
the results are used to respond to item 11.
4. Facial Palsy: Ask – or use pantomime to encourage
– the patient to show teeth or raise eyebrows and 0 = Normal symmetrical movements.
close eyes. Score symmetry of grimace in response
to noxious stimuli in the poorly responsive or 1 = Minor paralysis (flattened nasolabial fold,
noncomprehending patient. If facial asymmetry on smiling). ____________
