π§ NIH Stroke Scale (NIHSS)
Standardised stroke severity assessment β used globally for thrombolysis decisions and clinical trials
Used daily by neurologists, emergency physicians, and stroke coordinators. 100% clientβside, private.
π 11 items
π©Ί Score 0β42
βοΈ Thrombolysis guidance
π Clinical context: NIHSS is the gold standard for quantifying stroke deficit. Score β₯ 25 suggests severe stroke; score β€ 5 suggests mild stroke. Used to guide thrombolysis and predict outcomes.
1a. Level of Consciousness (LOC)
1b. LOC Questions (month, age)
1c. LOC Commands (open/close eyes, make fist)
2. Best Gaze (eye movement)
3. Visual Fields
4. Facial Palsy
5. Motor Arm (left & right, separate scores)
6. Motor Leg (left & right, separate scores)
7. Limb Ataxia
8. Sensory
9. Best Language (aphasia)
10. Dysarthria
11. Extinction and Inattention (neglect)
NIH Stroke Scale Score
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π Interpretation & Clinical Guidance
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π What is the NIH Stroke Scale?
The National Institutes of Health Stroke Scale (NIHSS) is a 15βitem neurological examination used to objectively quantify the severity of strokeβrelated deficit. It is the gold standard for acute stroke assessment.
Score range: 0 (normal) to 42 (maximum deficit). Scores β₯ 25 indicate very severe stroke; scores β€ 5 suggest mild stroke.
Used for:
- Thrombolysis (tPA) decisionβmaking
- Predicting outcomes
- Stratifying patients for clinical trials
- Tracking neurological change
β¨ Clinical Utility
- Score 0β4: Minor stroke β may still benefit from tPA
- Score 5β15: Moderate stroke β clear deficit, tPA often indicated
- Score 16β20: Moderate to severe β higher risk of complications
- Score 21β42: Severe stroke β poor prognosis, often require ICU
π‘ Pro tip: A change of β₯ 4 points between serial examinations is considered clinically significant.
β οΈ Important Considerations
- NIHSS requires formal training for reliable use; this tool is for educational and reference purposes.
- For intubated, aphasic, or obtunded patients, some items may be untestable β document reasons.
- Always use clinical judgment alongside the scale.
β Frequently Asked Questions
Most guidelines require NIHSS β₯ 4 for intravenous tPA, but individual protocols vary. Some treat patients with disabling deficits even with low scores.
At baseline, after tPA (2 hours), every 4β8 hours for first 24 hours, then daily or with changes in neurological status.
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