NIH Stroke Scale - Simplified & Added Cranial Nerves 2023

NIH Stroke Scale - Simplified & Added Cranial Nerves 2023. patient awake? Are they responsive when you enter the room? Opening eyes. 3 is scored if patient makes no movement. GC : Pt. has eye opening, verbal, and motor response. 0 = A ; keenly responsive 1 = N A ; but arousable by minor stimulation to obey, answer, or respond 2 = N A ; requires repeated or painful stimulation to attend 3 = ________ N : VIII vestibulocochlear Concerned with hearing and balance, why we make sure they can hear us. : Alertness 1 . LOC : Ask the Month and age/DOB. Answer must be correct first time with no help from nurse. 0 = Answers both correctly 1 = Answers 1 correctly. 2 = Answers 0 correctly ________ N : : Awareness, orientation 1 . LOC C : Patient open and close eyes. Clench fist on both hands (or substitute command if hands can t be used), etc. *not testing weakness, only if commands are being followed* 0 = performs both correctly 1 = performs 1 task correctly 2 = performs neither task correctly ________ N : : Ability to control motor responses and follow direction 2. B G : Horizontal and vertical eye movements. Move pen or finger side to side, & up and down. Also test pupillary reflex to light. 0 = normal 1 = partial gaze palsy: eyes only move in one direction 2 = forced deviation: eyes do not move & are stuck in one position ________ N : III, IV, VI Concerned with eye rotation, movement, and pupillary reaction : Eye movement, pupil reaction