NIHSS Calculator

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NIHSS Calculator

NIH Stroke Scale

Total Score

Items Completed

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Score Summary

Normal

Progress: 0/15 0%

Coma Patient Auto-Scoring

NINDS Guidelines Auto-Scoring Applied

1a. Level of Consciousness

Assess the patient's basic level of consciousness. Selecting coma may trigger automatic scoring suggestions for some items.

0 = Alert: Normal response

Patient is alert and responds normally

1 = Drowsy: Awakens to minor stimulation

Aroused by minor stimulation

2 = Stuporous: Requires repeated stimulation

Requires repeated or painful stimulation

3 = Coma: No response

No response to painful stimuli or only reflex responses

1b. LOC Questions

Ask patient their age and current month. Score 2 if unable to answer due to coma, aphasia, or intubation.

Questions:

• What is your age?
• What month is it?

0 = Both questions correct

Correctly answers both age and current month

1 = One question correct

Correctly answers only one question (Intubated: default 1 point)

2 = Both incorrect or no response

Both questions wrong or unable to answer (Coma: 2 points)

1c. LOC Commands

Ask patient to "close your eyes" and "make a fist". Aphasic patients may be shown by gesture.

Commands:

• Close eyes
• Make fist

0 = Performs both tasks

Performs both eye closing and fist clenching

1 = Performs one task

Performs only one of the two tasks

2 = Performs neither task

Unable to perform either task (Coma: 2 points)

2. Best Gaze

Test horizontal eye movements. In unconscious patients, use doll's eye reflex or cold water stimulation.

0 = Normal

Normal horizontal eye movements

1 = Partial gaze palsy

Abnormal but no forced deviation

2 = Forced deviation or complete gaze palsy

Eyes deviated to one side or complete gaze palsy

3. Visual Fields

Test visual fields. In unconscious patients, use blink to threat response.

0 = No visual field defect

Normal visual fields

1 = Partial hemianopia

Partial visual field defect

2 = Complete hemianopia

Complete half visual field loss

3 = Bilateral hemianopia

Bilateral visual field loss (including cortical blindness)

4. Facial Palsy

Ask patient to smile or show teeth. In unconscious patients, observe grimace to painful stimuli.

0 = Normal symmetrical movement

Normal facial movement

1 = Minor paralysis

Minor asymmetry when smiling

2 = Partial paralysis

Clear lower facial paralysis

3 = Complete paralysis

Complete upper and lower facial paralysis (Coma: 3 points)

5a. Motor Arm - Right

Hold arm at 90° when sitting, 45° when supine for 10 seconds. Score UN for amputation or joint fusion.

0 = No drift

Maintains 90° for 10 seconds

1 = Drift

Drifts down but doesn't hit bed

2 = Some effort against gravity

Some effort against gravity but can't maintain 90°

3 = No effort against gravity

Falls but moves only with gravity

4 = No movement

No movement at all (Coma: 4 points)

UN = Amputation or joint fusion

Unable to assess due to amputation or shoulder fusion

5b. Motor Arm - Left

Hold arm at 90° when sitting, 45° when supine for 10 seconds. Score UN for amputation or joint fusion.

0 = No drift

Maintains 90° for 10 seconds

1 = Drift

Drifts down but doesn't hit bed

2 = Some effort against gravity

Some effort against gravity but can't maintain 90°

3 = No effort against gravity

Falls but moves only with gravity

4 = No movement

No movement at all (Coma: 4 points)

UN = Amputation or joint fusion

Unable to assess due to amputation or shoulder fusion

6a. Motor Leg - Right

Hold leg at 30° in supine position for 5 seconds. Score UN for amputation or joint fusion.

0 = No drift

Maintains 30° for 5 seconds

1 = Drift

Drifts down but doesn't hit bed

2 = Some effort against gravity

Some effort against gravity but can't maintain 30°

3 = No effort against gravity

Falls but moves only with gravity

4 = No movement

No movement at all (Coma: 4 points)

UN = Amputation or joint fusion

Unable to assess due to amputation or hip fusion

6b. Motor Leg - Left

Hold leg at 30° in supine position for 5 seconds. Score UN for amputation or joint fusion.

0 = No drift

Maintains 30° for 5 seconds

1 = Drift

Drifts down but doesn't hit bed

2 = Some effort against gravity

Some effort against gravity but can't maintain 30°

3 = No effort against gravity

Falls but moves only with gravity

4 = No movement

No movement at all (Coma: 4 points)

UN = Amputation or joint fusion

Unable to assess due to amputation or hip fusion

7. Limb Ataxia

Perform finger-nose-finger and heel-shin tests. Exclude weakness. Score 0 if unconscious or paralyzed.

0 = Absent

No ataxia (Coma: 0 points - untestable)

1 = Present in one limb

Ataxia in one limb only

2 = Present in two limbs

Ataxia in two limbs

8. Sensory

Test with pin or safety pin. In comatose or aphasic patients, observe for grimace or withdrawal response.

0 = Normal; no sensory loss

Normal sensation

1 = Mild-to-moderate sensory loss

Partial sensory loss

2 = Severe or complete sensory loss

Severe sensory loss (Coma: 2 points)

9. Best Language

Ask patient to describe pictures or read sentences. Intubated patients can be assessed by writing.

0 = No aphasia

Normal language function

1 = Mild-to-moderate aphasia

Clear communication limitation

2 = Severe aphasia

Very limited communication

3 = Mute/global aphasia

No language comprehension or expression (Coma: 3 points)

10. Dysarthria

Have patient speak specific words. Intubated patients must be scored as UN.

0 = Normal

Normal articulation

1 = Mild-to-moderate

Mild articulation difficulty

2 = Severe dysarthria

Severe articulation difficulty, hard to understand (Coma: 2 points)

UN = Intubated or other physical barrier

Unable to assess (Intubated: UN)

11. Extinction and Inattention

Assess patient for neglect or extinction phenomena. Visual neglect is most common.

0 = No abnormality

Normal

1 = Visual, tactile, auditory, spatial, or personal inattention

Inattention in one modality

2 = Profound hemi-inattention

Severe neglect (Coma: 2 points)

Score Interpretation

Normal

1-4

Mild

5-15

Moderate

16-20

Moderate-Severe

21-42

Severe

Current Score

0 Normal

15 remaining