Press F5 for sound on the presentation NIHSS Level of consciousness Alert 0 points Drowsy 1 point Stupor 2 points Coma 3 points ID: 699846
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Slide1
NIH Stroke ScaleThe Good, The Bad, and The Ugly
Press F5 for sound on the presentationSlide2
NIHSSLevel of consciousness
Alert 0 points
Drowsy 1 pointStupor 2 pointsComa 3 pointsSlide3
NIHSSQuestions Month/Age
Answer both correctly 0 pointsAnswers one correctly 1 point
None are correct 2 pointsSlide4
NIHSSResponse to 2 Commands
Follows 2 command correctly 0 pointsFollows 1 command correctly 1 point
Cannot follow either command 2 pointsSlide5
NIHSSBest Gaze
Normal 0 pointsPartial gaze to one side 1 point
Forced gaze to one side 2 pointsSlide6
NIHSSVisual Fields
No visual loss 0 pointsPartial hemianopsia 1 point
Complete hemianopsia 2 pointsBilateral visual loss 3 pointsSlide7
NIHSSFacial Motor Function
No weakness 0 pointsMinor unilateral weakness 1 point
Partial unilateral weakness 2 pointsComplete uni or bilateral weakness 3 pointsSlide8
NIHSSUpper Extremity Motor Function
(Right and Left Scored Independently)
Normal 0 pointsDrift 1 pointSome effort against gravity 2 points
No effort against gravity 3 pointsNo movement 4 pointsSlide9
NIHSSLower Extremity Motor Function
(Right and Left Scored Independently)
Normal 0 pointsDrift 1 point
Some effort against gravity 2 pointsNo effort against gravity 3 pointsNo movement 4 pointsSlide10
NIHSSExtremity Ataxia(Cannot Be Tested in Presence of Paresis)
No ataxia 0 points
Ataxia in 1 extremity 1 pointAtaxia in 2 extremities 2 pointsSlide11
NIHSSSensory Loss
Normal 0 pointsMild to moderate loss 1 point
Severe to total loss 2 pointsSlide12
NIHSSLanguage
No aphasia 0 pointsMild to moderate aphasia 1 point
Severe aphasia 2 pointsMute 3 pointsSlide13
NIHSSArticulation (Dysarthia)
Normal 0 points
Mild to moderate 1 pointSevere 2 pointsSlide14
NIHSSExtinction/Inattention
No abnormality 0 points
Extinction to one modality 1 pointExtinction to 2 modalities 2 pointsSlide15
The GoodReliable
Interrater reliability confirmed
ValidTime efficientOriginal trial had a 6 minute average
Cell phone with video capability takes 38 seconds longer than bedside examinationSlide16
The BadTendency to favor speech/language function over higher integrated sensory function
L MCA infarcts average 4 points higher than R MCA infarctsSome items represent redundancy
Ataxia with gross motor functionDysarthria with aphasiaToo often ataxia is over representedSlide17
The UglyBrainstem/cerebellar
function overly minimized
Not a good scale for the “dizzy plus” patient