NIH Stroke Scale/Score
(NIHSS)/2023
Calculates the NIH Stroke Scale for quantifying stroke severity.
Note: The NIH Stroke Scale requires that you understand the neurologic exam and has many
caveats buried within it; if your patient has any prior known neurologic deficits (prior weakness,
hemi- or quadriplegia, blindness, etc.), it becomes especially complicated; you should consult the
NIH Stroke Scale website. MDCalc's version is an attempt to clarify many of these confusing
caveats, but cannot and should not be substituted for the official protocol.
1A: Level of Consciousness
Alert; keenly responsive
0
Arouses to minor stimulation
+1
Requires repeated stimulation to arouse
+2
Movements to Pain
+2
Postures or Unresponsive
+3
1B: Ask Month and Age
Both Questions Right
0
1 Question Right
+1
0 Questions Right
+2
Dysarthric/Intubated/ Trauma/Language Barrier
+1
Aphasic
+2
1C: 'Blink Eyes' & 'Squeeze Hands'
(Pantomime Commands if Communication Barrier)
Performs Both Tasks
0
Performs 1 Task
+1
, Performs 0 Tasks
+2
2: Test Horizontal Extraocular Movements
Normal
0
Partial Gaze Palsy: Can Be Overcome
+1
Partial Gaze Palsy: Corrects with Oculocephalic Reflex
+1
Forced Gaze Palsy: Cannot Be Overcome
+2
3: Test Visual Fields
No Visual Loss
0
Partial Hemianopia
+1
Complete Hemianopia
+2
Patient is Bilaterally Blind
+3
Bilateral Hemianopia
+3
4: Test Facial Palsy
(Use Grimace if Obtunded)
Normal symmetry
0
Minor paralysis (flat nasolabial fold, smile asymetry)
+1
Partial paralysis (lower face)
+2
Unilateral Complete paralysis (upper/lower face)
+3
Bilateral Complete paralysis (upper/lower face)
+3
5A: Test Left Arm Motor Drift
No Drift for 10 Seconds
0
Drift, but doesn't hit bed
+1
(NIHSS)/2023
Calculates the NIH Stroke Scale for quantifying stroke severity.
Note: The NIH Stroke Scale requires that you understand the neurologic exam and has many
caveats buried within it; if your patient has any prior known neurologic deficits (prior weakness,
hemi- or quadriplegia, blindness, etc.), it becomes especially complicated; you should consult the
NIH Stroke Scale website. MDCalc's version is an attempt to clarify many of these confusing
caveats, but cannot and should not be substituted for the official protocol.
1A: Level of Consciousness
Alert; keenly responsive
0
Arouses to minor stimulation
+1
Requires repeated stimulation to arouse
+2
Movements to Pain
+2
Postures or Unresponsive
+3
1B: Ask Month and Age
Both Questions Right
0
1 Question Right
+1
0 Questions Right
+2
Dysarthric/Intubated/ Trauma/Language Barrier
+1
Aphasic
+2
1C: 'Blink Eyes' & 'Squeeze Hands'
(Pantomime Commands if Communication Barrier)
Performs Both Tasks
0
Performs 1 Task
+1
, Performs 0 Tasks
+2
2: Test Horizontal Extraocular Movements
Normal
0
Partial Gaze Palsy: Can Be Overcome
+1
Partial Gaze Palsy: Corrects with Oculocephalic Reflex
+1
Forced Gaze Palsy: Cannot Be Overcome
+2
3: Test Visual Fields
No Visual Loss
0
Partial Hemianopia
+1
Complete Hemianopia
+2
Patient is Bilaterally Blind
+3
Bilateral Hemianopia
+3
4: Test Facial Palsy
(Use Grimace if Obtunded)
Normal symmetry
0
Minor paralysis (flat nasolabial fold, smile asymetry)
+1
Partial paralysis (lower face)
+2
Unilateral Complete paralysis (upper/lower face)
+3
Bilateral Complete paralysis (upper/lower face)
+3
5A: Test Left Arm Motor Drift
No Drift for 10 Seconds
0
Drift, but doesn't hit bed
+1
