NIH Stroke Scale

Patient Name:

Date + Time of Exam:

1a. Level of Consciousness

0 = Alert; keenly responsive

1 = Not alert; but arousable by minor stimulation to obey, answer, or respond

2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped)

3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid and areflexic

1b. Level of Consciousness Questions

0 = Answers both questions correctly

1 = Answers one question correctly

2 = Answers neither question correctly

1c. Level of Consciousness Commands

0 = Performs both tasks correctly

1 = Performs one task correctly

2 = Performs neither task correctly

2. Best Gaze

0 = Normal

1 = Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.

2 = Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver.

3. Visual

0 = No visual loss.

1 = Partial hemianopia.

2 = Complete hemianopia.

3 = Bilateral hemianopia (blind including cortical blindness).

4. Facial Palsy

0 = Normal symmetrical movements.

1 = Minor paralysis (flattened nasolabial fold, asymmetry on smiling)

2 = Partial paralysis (total or near-total paralysis of lower face).

3 = Complete paralysis of one or both sides (absence of facial movement in the upper and lower face).

5. Motor Arm
5a. Left arm

Reason for L arm untestable:

0 = No drift. limb holds 90 (or 45) degrees for full 10 seconds.

1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support.

2 = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.

3 = No effort against gravity; limb falls.

4 = No movement.

UN = Amputation or joint fusion, explain.

5b. Right arm

Reason for R arm untestable:

6. Motor Leg 6a. Left leg

Reason for L leg untestable:

0 = No drift. Leg holds 30 degrees for full 5 seconds.

1 = Drift; leg falls by the end of the 5-second period, but does not hit bed.

2 = Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity.

3 = No effort against gravity; leg falls to bed immediately.

4 = No movement.

UN = Amputation or joint fusion, explain.

6b. Right leg

Reason for R leg untestable:

7. Limb ataxia

Reason for Ataxia untestable:

0 = Absent.

1 = Present in one limb.

2 = Present in two limbs.

UN = Amputation or joint fusion, explain.

8. Sensory

0 = Normal; no sensory loss.

1 = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched.

2 = Severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg.

9. Best Language

0 = No aphasia; normal.

1 = Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation of ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided materials difficult or impossible. For example, in conversation about provided materials, examiner can identify picture or naming card content from patient's response.

2 = Severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited; listener carries burden of communication. Examiner cannot identify materials provided from patient response.

3 = Mute, global aphasia; no usable speech or auditory comprehension.

10. Dysarthria

Reason for Dysarthria untestable:

0 = Normal.

1 = Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty.

2 = Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence and out of proportion to any dysphasia, or is mute/anarthric.

UN = Intubated or other physical barrier, explain.

11. Extinction and Inattention

0 = No abnormality.

1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities.

2 = Profound hemi-attention or extinction to more than on modality; does not recognize own hand or orients to only one side of space.

1a. Level of Consciousness	0 = Alert; keenly responsive 1 = Not alert; but arousable by minor stimulation to obey, answer, or respond 2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped) 3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid and areflexic
1b. Level of Consciousness Questions	0 = Answers both questions correctly 1 = Answers one question correctly 2 = Answers neither question correctly
1c. Level of Consciousness Commands	0 = Performs both tasks correctly 1 = Performs one task correctly 2 = Performs neither task correctly
2. Best Gaze	0 = Normal 1 = Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present. 2 = Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver.
3. Visual	0 = No visual loss. 1 = Partial hemianopia. 2 = Complete hemianopia. 3 = Bilateral hemianopia (blind including cortical blindness).
4. Facial Palsy	0 = Normal symmetrical movements. 1 = Minor paralysis (flattened nasolabial fold, asymmetry on smiling) 2 = Partial paralysis (total or near-total paralysis of lower face). 3 = Complete paralysis of one or both sides (absence of facial movement in the upper and lower face).
*5. Motor Arm* 5a. Left arm Reason for L arm untestable:	0 = No drift. limb holds 90 (or 45) degrees for full 10 seconds. 1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support. 2 = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity. 3 = No effort against gravity; limb falls. 4 = No movement. UN = Amputation or joint fusion, explain.
5b. Right arm Reason for R arm untestable:
*6. Motor Leg* 6a. Left leg Reason for L leg untestable:	0 = No drift. Leg holds 30 degrees for full 5 seconds. 1 = Drift; leg falls by the end of the 5-second period, but does not hit bed. 2 = Some effort against gravity; leg falls to bed by 5 seconds, but has some effort against gravity. 3 = No effort against gravity; leg falls to bed immediately. 4 = No movement. UN = Amputation or joint fusion, explain.
6b. Right leg Reason for R leg untestable:
7. Limb ataxia Reason for Ataxia untestable:	0 = Absent. 1 = Present in one limb. 2 = Present in two limbs. UN = Amputation or joint fusion, explain.
8. Sensory	0 = Normal; no sensory loss. 1 = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched. 2 = Severe to total sensory loss; patient is not aware of being touched in the face, arm, and leg.
9. Best Language	0 = No aphasia; normal. 1 = Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation of ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided materials difficult or impossible. For example, in conversation about provided materials, examiner can identify picture or naming card content from patient's response. 2 = Severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited; listener carries burden of communication. Examiner cannot identify materials provided from patient response. 3 = Mute, global aphasia; no usable speech or auditory comprehension.
10. Dysarthria Reason for Dysarthria untestable:	0 = Normal. 1 = Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty. 2 = Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence and out of proportion to any dysphasia, or is mute/anarthric. UN = Intubated or other physical barrier, explain.
11. Extinction and Inattention	0 = No abnormality. 1 = Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities. 2 = Profound hemi-attention or extinction to more than on modality; does not recognize own hand or orients to only one side of space.