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NIH Stroke Scale (NIHSS)

The universal language of acute stroke severity — and it systematically under-scores right-hemisphere strokes.

No stroke symptoms
NIHSS 0
Level of consciousness
1a. Level of consciousness
1b. LOC questions — ask the month and the patient's age
1c. LOC commands — open/close eyes, grip and release non-paretic hand
Cranial nerves
2. Best gaze — horizontal eye movements only
3. Visual fields — by confrontation or visual threat
4. Facial palsy — show teeth, raise eyebrows, close eyes tightly
Motor
5a. Left arm motor — extend 90° sitting or 45° supine, hold 10 seconds
5b. Right arm motor — extend 90° sitting or 45° supine, hold 10 seconds
6a. Left leg motor — extend 30° supine, hold 5 seconds
6b. Right leg motor — extend 30° supine, hold 5 seconds
7. Limb ataxia — finger-nose-finger and heel-shin
Sensory, language, and attention
8. Sensory — pin-prick to face, arm, trunk, leg
9. Best language — describe the picture, name items, read sentences
10. Dysarthria — read or repeat words, judge articulation
11. Extinction / inattention — simultaneous bilateral visual and tactile stimulation
NIH Stroke Scale · a public-domain instrument of the US National Institutes of Health · The scale under-scores right-hemisphere and posterior circulation strokes — language is worth up to 3 points, neglect and ataxia only 2 each. Always pair the number with the clinical picture; a low NIHSS with a disabling deficit is still a disabling deficit.