NIH Stroke Scale
Study online at https://quizlet.com/_g03oia
1. Part 1 (a, b, c) *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
2. Part 2-3 *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
3. Part 4 *FACE* - Ask patient to smile and raise eyebrows. If obtunded, use grimace to
pain.
1/4
Study online at https://quizlet.com/_g03oia
1. Part 1 (a, b, c) *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
2. Part 2-3 *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
3. Part 4 *FACE* - Ask patient to smile and raise eyebrows. If obtunded, use grimace to
pain.
1/4
