NIH Stroke Scale (NIHSS)

Assess responsiveness. Choose the best response — even if impaired by intubation, language barrier, or orotracheal trauma.

Ask patient their age and the current month. Score the first answer only. Score 1 for each incorrect — do not coach.

"Open and close your eyes." "Grip and release your non-paretic hand." Credit if unequivocal attempt is made but not completed due to weakness.

Test horizontal eye movements only. Score gaze with oculocephalic testing in obtunded patients. Score 1 if isolated cranial nerve palsy (III, IV, VI).

Test by confrontation (finger counting or visual threat). Score visual field loss confirmed by double simultaneous stimulation. If blind from any cause, score 3.

Ask patient to show teeth, raise eyebrows, and close eyes tightly. Score symmetry of grimace in response to pain in poorly responsive patients.

Arm outstretched 90° (sitting) or 45° (supine) for 10 seconds. Encourage best effort. Score each arm separately.

Arm outstretched 90° (sitting) or 45° (supine) for 10 seconds. Encourage best effort. Score each arm separately.

Leg raised 30° (supine) for 5 seconds. Score each leg separately.

Leg raised 30° (supine) for 5 seconds. Score each leg separately.

Finger-nose-finger and heel-shin tests. Ataxia must be out of proportion to weakness. Score ataxia only if present — not due to weakness or comprehension deficit.

Test with pinprick or withdrawal from noxious stimulus. Score sensory loss only attributable to stroke. Test face, arms, trunk, legs.

Ask patient to describe a standard picture, name items, and read sentences. Score comprehension from responses throughout the exam. Score 3 for mute/global aphasia.

Ask patient to read or repeat words from a standard list. Judge clarity of articulation. If intubated, score 0 only if clearly normal.

Test with double simultaneous stimulation (visual and tactile). Score 2 if profound hemi-inattention or extinction to more than one modality.