730:, one leg is placed 30 degrees above horizontal. As soon as the patient's leg is in position the investigator should begin verbally counting down from 5 while simultaneously counting down on his or her fingers in full view of the patient. Observe any downward leg drift prior to the end of the 5 seconds. Downward movement that occurs directly after the investigator places the patient's leg in position should not be considered downward drift. Repeat this test for the opposite leg. Scores for this section should be recorded separately as 6a and 6b for the left and right legs respectively.
644:
begin verbally counting down from 10 while simultaneously counting down on his or her fingers in full view of the patient. Observe to detect any downward arm drift prior to the end of the 10 seconds. Downward movement that occurs directly after the investigator places the patient's arm in position should not be considered downward drift. Repeat this test for the opposite arm. This item should be scored for the right and left arm individually, denoted as item 5a and 5b.
1315:
The
National Institutes of Health Stroke Scale has been repeatedly validated as a tool for assessing stroke severity and as an excellent predictor for patient outcomes. Severity of a stroke is heavily correlated with the volume of brain affected by the stroke; strokes affecting larger portions of the
1307:(tPA) and which patients are likely to have good clinical outcomes. The mNIHSS has also recently been shown to be taken without seeing the patient, and only using medical records. This potentially improves care while in the emergency room and the hospital, but also facilitates retrospective research.
1167:
The NIHSS is then repeated at regular intervals or after significant changes in patient condition. This history of scores can then be utilized to monitor the effectiveness of treatment methods and quantify a patient's improvement or decline. The NIHSS has also been used in a prospective observational
467:
Assess the patient's vision in each visual fields. Each eye is tested individually, by covering one eye and then the other. Each upper and lower quadrant is tested by asking the patient to indicate how many fingers the investigator is presenting in each quadrant. The investigator should instruct the
50:
first published by neurologist Dr. Patrick Lyden and colleagues in 2001. Prior to the NIHSS, during the late 1980s, several stroke-deficit rating scales were in use (e.g., University of
Cincinnati scale, Canadian neurological scale, the Edinburgh-2 coma scale, and the Oxbury initial severity scale).
1220:
In an effort to produce a complete neurological assessment the NIHSS was developed after extensive research and multiple iterations. The goal of the NIHSS was to accurately measure holistic neurological function by individually testing specific abilities. NIHSS total score is based on the summation
145:
Scores for this item are assigned by a medical practitioner based on the stimuli required to arouse patient. The examiner should first assess if the patient is fully alert to his or her surroundings. If the patient is not completely alert, the examiner should attempt a verbal stimulus to arouse the
49:
and aid planning post-acute care disposition, though was intended to assess differences in interventions in clinical trials. The NIHSS was designed for the
National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator (rt-PA) for Acute Stroke Trial and was
1104:
To test extinction in vision, the examiner should hold up one finger in front of each of the patient's eyes and ask the patient to determine which finger is wiggling or if both are wiggling. The examiner should then alternate between wiggling each finger and wiggling both fingers at the same time.
643:
With palm facing downwards, have the patient extend one arm 90 degrees out in front if the patient is sitting, and 45 degrees out in front if the patient is lying down. If necessary, help the patient get into the correct position. As soon as the patient's arm is in position the investigator should
133:
Level of consciousness (LOC) testing is divided into three sections. The first LOC items test for the patient's responsiveness. The second LOC item is based on the patient's ability to answer questions that are verbally presented by the examiner. The final LOC sub-section is based on the patient's
117:
While administering the NIHSS, it is important that the examiner does not coach or help with the assigned task. The examiner may demonstrate the commands to patients that are unable to comprehend verbal instructions; however, the score should reflect the patient's own ability. It is acceptable for
1328:
The NIHSS places 7 of the possible 42 points on abilities that require verbal skills; 2 points from the LOC questions, 2 points from LOC commands, and 3 points from the
Language item. The NIHSS only awards 2 points for extinction and inattention. Approximately 98% of humans have verbal processing
948:
This item measures the patient's language skills. After completing items 1-8, it is likely the investigator has gained an approximation of the patient's language skills; however, it is important to confirm this measurement at this time. The stroke scale includes a picture of a scenario, a list of
468:
patient to maintain eye contact throughout this test, and not allow the patient to realign focus towards each stimulus. With the first eye covered, place a random number of fingers in each quadrant and ask the patient how many fingers are being presented. Repeat this testing for the opposite eye.
1195:
The effectiveness and risk of tPA is strongly correlated with the delay between stroke onset and tPA delivery ("door-to-needle time"). Current standards recommend for tPA to be delivered within 4,5 hours of onset, while best results occur when treatment is delivered within 90 minutes of onset.
816:
cerebellar lesion, and distinguishes a difference between general weakness and incoordination. The patient should be instructed to first touch his or her finger to the examiner's finger then move that finger back to his or her nose, repeat this movement 3-4 times for each hand. Next the patient
1341:
The NIHSS has been found to be an excellent predictor of patient outcomes. A baseline NIHSS score greater than 16 indicates a strong probability of patient death, while a baseline NIHSS score less than 6 indicates a strong probability of a good recovery. On average, an increase of 1 point in a
1199:
Since the NIHSS has been established as a quick and consistent quantifier of stroke severity, many physicians have looked to NIHSS scores as indicators for tPA treatment. This rapid assessment of stroke severity is targeted to reduce delay of tPA treatment. While some clinical trials have used
952:
Next, the patient should read the list of sentences and name each of the objects depicted in the next figure. The scoring for this item should be based on both the results from the test performed in this item in addition to the language skills demonstrated up to this point in the stroke scale.
1100:
Double simultaneous stimulation is performed by having the patient close his or her eyes and asking him or her to identify the side on which they are being touched by the examiner. During this time, the examiner is alternating between touching the patient on the right and left side. Next, the
1162:
The NIHSS was designed to be a standardized and repeatable assessment of stroke patients utilized by large multi-center clinical trials. Clinical researchers have widely accepted this scale due to its high scoring consistency, which has been demonstrated in inter-examiner and in test-retest
1038:
regions. These brain regions are vital in coordinating motor control of the tongue, throat, lips, and lungs. To perform this item the patient is asked to read from the list of words provided with the stroke scale while the examiner observes the patient's articulation and clarity of speech.
1333:. This results in lesions receiving a higher (worse) score when occurring in the left hemisphere, compared to lesions of equal size in the right hemisphere. Due to this emphasis, the NIHSS is a better predictor of lesion volume in the strokes occurring within the left cerebral hemisphere.
553:
of each facial expression the examiner should first instruct patient to show his or her teeth (or gums). Second, the patient should be asked to squeeze his or her eyes closed as hard as possible. After reopening his or her eyes, the patient is then instructed to raise his or her eyebrows.
548:
Facial palsy is partial or complete paralysis of portions of the face. Typically this paralysis is most pronounced in the lower half of one facial side. However, depending on lesion location the paralysis may be present in other facial regions. While inspecting the
1096:
Sufficient information regarding this item may have been obtained by the examiner in items 1–10 to properly score the patient. However, if any ambiguity exist the examiner should test this item via a technique referred to as "double simultaneous stimulation".
2095:
Frankel MR, Morgenstern LB, Kwiatkowski T, Lu M, Tilley BC, Broderick JP, Libman R, Levine SR, Brott T (2000). "Predicting prognosis after stroke: a placebo group analysis from the
National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial".
1299:
The
Modified NIH Stroke Scale (mNIHSS) is a shortened, validated version of the mNIHSS. It has been shown to be equally, if not more, accurate than the longer, older NIHSS. It removes questions 1A, 4, and 7. This makes the mNIHSS shorter and easier to use.
1021:
Dysarthria is the lack of motor skills required to produce understandable speech. Dysarthria is strictly a motor problem, and is not related to the patient's ability to comprehend speech. Strokes that cause dysarthria typically affect areas such as the
121:
For each item, the examiner should score the patient's first effort, and repeated attempts should not affect the patient's score. An exception to this rule exist in the language assessment (Item 9), in which the patient's best effort should be scored.
53:
The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.
1639:
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S (1999). "Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset: the ATLANTIS study: a randomized con- trolled trial".
1719:
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999). "Intra-arterial prourokinase for ischemic stroke: the PROACT II study: a randomized controlled trial".
440:
If patient is unable to follow the command to track an object, the investigator can make eye contact with the patient and then move side to side. The patient's gaze palsy can then be assessed by his or her ability to maintain eye
1390:
NIH Stroke Scale
Training, Part 2. Basic Instruction. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke. The National Institute of Neurological Disorders and Stroke (NINDS) Version
1520:
Schimmel M, Leemann B, Christou P, Kiliaridis S, Herrmann F, Muller F. Quantitative assessment of facial muscle impairment in patients with hemispheric stroke. Journal of Oral
Rehabilitation . n.d.;NOV, 2011, 38.11, p800-p809,
146:
patient. Failure of verbal stimuli indicates an attempt to arouse the patient via repeated physical stimuli. If none of these stimuli are successful in eliciting a response, the patient can be considered totally unresponsive.
538:
If patient is not responsive the visual fields can be tested by visual threat (the investigator moving an object towards the eye and observing the patient's response, being careful not to trigger the corneal reflex with air
887:
portion of all four limbs. While applying pinpricks, the investigator should ask whether or not the patient feels the pricks, and if he or she feels the pricks differently on one side when compared to the other side.
1221:
of 4 factors. These factors are left and right motor function and left and right cortical function. The NIHSS assesses each of these specific functions by the stroke scale item listed in the chart below.
2182:"Age and national institutes of health stroke scale score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia - Development and external validation of prognostic models"
1342:
patient's NIHSS score decreases the likelihood of an excellent outcome by 17%. However, correlation between functional recovery and NIHSS scores was weaker when the stroke was isolated to the cortex.
1846:"Thrombolysis Is Associated With Consistent Functional Improvement Across Baseline Stroke Severity: A Comparison of Outcomes in Patients From the Virtual International Stroke Trials Archive (VISTA)"
1890:"Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for pa- tients with right- and left-hemisphere ischemic stroke?"
2308:
Adams H, Davis P, Hansen M, et al. (1999). "Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke
Treatment (TOAST)".
118:
the examiner to physically help the patient get into position to begin the test, but the examiner must not provide further assistance while the patient is attempting to complete the task.
125:
Some of the items contain "Default Coma Scores". These scores are automatically assigned to patients that scored a 3 in Item 1a. Note that the NIHSS may fluctuate depending on the time.
677:
Limited effort against gravity; the arm is able to obtain the starting position, but drifts down from the initial position to a physical support prior to the end of the 10 seconds
763:
Limited effort against gravity; the leg is able to obtain the starting position, but drifts down from the initial position to physical support prior to the end of the 5 seconds
1929:
Lyden P, Lu M, Jackson C, Marler J, Kothari R, Brott T, Zivin J (1999). "Underlying structure of the
National Institutes of Health Stroke Scale: results of a factor analysis".
685:
No effort against gravity; the arm falls immediately after being helped to the initial position, however the patient is able to move the arm in some form (e.g. shoulder shrug)
1830:
Eissa A, Krass I, Bajorek B. "Optimizing the management of acute ischaemic stroke: a review of the utilization of intravenous recombinant tissue plasminogen activator (tPA).
1316:
brain tend to have more detrimental effects. NIHSS scores have been found to be reliable predictors of damaged brain volume, with a smaller NIHSS score indicating a smaller
771:
No effort against gravity; the leg falls immediately after being helped to the initial position, however, the patient is able to move the leg in some form (e.g. hip flex)
57:
The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0.
2005:
363:
Assesses ability for patient to track a pen or finger from side to side only using his or her eyes. This is designed to assess motor ability to gaze towards the
939:
For patients unable to understand the instructions, the pinprick can be replaced by a noxious stimulus and the grimace can be judged to determine sensory score.
949:
simple sentences, a figure of assorted random objects, and a list of words. The patient should be asked to explain the scenario depicted in the first figure.
1757:"Combined intra- venous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke. Emergency Management of Stroke (EMS) Bridging Trial"
1796:
Yoo, SH; Kim, JS; Kwon, SU; Yun, SC; Koh, JY; Kang, DW (2008). "Undernutrition as a Predictor of Poor Clinical Outcomes in Acute Ischemic Stroke Patients".
817:
should be instructed to move his or her heel up and down the shin of his or her opposite leg. This test should be repeated for the other leg as well.
936:
The investigator should insure that the sensory loss being detected is a result of the stroke, and should therefore test multiple spots on the body.
2224:
Glymour M, Berkman L, Ertel K, Fay M, Glass T, Furie K (2007). "Lesion characteristics, NIH Stroke Scale, and functional recovery after stroke".
2411:
978:
Mild-to-moderate aphasia; detectable loss in fluency, however, the examiner should still be able to extract information from patient's speech
448:. This is done by manually turning the patient's head from midline to one side and assessing the eye's reflex to return to a midline position.
371:(CED) is present in approximately 20% of stroke cases. CED is more common in right hemispheric strokes and typically in lesions affecting the
347:
If the patient does not understand the command, the command can be visually demonstrated to him or her without an impact on his or her score
2060:
Muir KW, Weir CJ, Murray GD, Povey C, Lees KR (1996). "Comparison of neurological scales and scoring systems for acute stroke prognosis".
755:
Drift; the leg drifts to an intermediate position prior to the end of the full 5 seconds, but at no point touches the bed for support
1680:"PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke"
1531:
Okuda B, Kawabata K, Tachibana H, Sugita M (1999). "Cerebral blood flow in pure dysarthria: role of frontal cortical hypoperfusion".
1163:
scenarios. Clinical research use of the NIHSS typically involves obtaining a baseline NIHSS score as soon as possible after onset of
1012:
This is an exception to recording only the patients first attempt. In this item, the patients best language skills should be recorded
1466:
669:
Drift; the arm drifts to an intermediate position prior to the end of the full 10 seconds, but not at any point relies on a support
1378:
714:
Motor Arm assessment should be skipped in the case of an amputee, however a note should be made in the scoring of the amputation.
1755:
Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, Starkman S, Grotta J, Spilker J, Khoury J, Brott T (1999).
535:
If patient is non-verbal, he or she can be allowed to respond by holding up the number of fingers the investigator is presenting
2421:
1966:"A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity"
1566:
Brott T, Adams HP, Olinger CP, et al. (1989). "Measurements of acute cerebral infarction—a clinical examination scale".
1200:
minimum and maximum NIHSS scores to determine eligibility for acute treatment such as tPA, guidelines such as those from the
1101:
examiner touches the patient on both sides at the same time. This should be repeated on the patients face, arms, and legs.
986:
Severe aphasia; all speech is fragmented, and examiner is unable to extract the figure's content from the patients speech.
2416:
36:
1304:
1177:
1072:
Severe dysarthria; speech is so slurred that he or she cannot be understood, or patients that cannot produce any speech
921:
Severe to total sensory loss on one side; patient is not aware he or she is being touched in all unilateral extremities
884:
341:
The hand grip command can be replaced with any other simple one step command if the patient cannot use his or her hands.
137:
Although this item is broken into three parts, each sub-section is added to the final score as if it is its own item.
800:
Motor leg assessment should be skipped in the case of an amputee, however a note should be made in the score records
1201:
1087:
An intubated patient should not be rated on this item, instead make note of the situation in the scoring documents.
1168:
study, to predict 3 month outcomes of patients with undernutrition during hospital stays directly after a stroke.
913:
Mild-to-Moderate sensory loss; patient feels the pinprick, however he or she feels as if it is duller on one side
1035:
354:, or other physical impediments can be given other simple one-step commands if these commands are not appropriate
803:
If patient is unable to understand commands, the investigator should deliver the instructions via demonstration
717:
If patient is unable to understand commands, the investigator should deliver the instructions via demonstration
623:
If the patient is unable to understand verbal commands, the instructions should be demonstrated to the patient.
376:
293:
The patient is instructed to first open and close his or her eyes and then grip and release his or her hand.
445:
1999:
379:. Damage to these areas can result in decreased spatial attention and reduced control of eye movements.
1377:
National Institutes of Health, National Institute of Neurological Disorders and Stroke. Stroke Scale.
405:
368:
344:
A patient's attempt is regarded as successful if an attempt is made but is incomplete due to weakness
408:; gaze is abnormal in one or both eyes, but gaze is not totally paralyzed. Patient can gaze towards
1188:
strokes (the type of stroke caused by blood clots that are preventing blood flow within a cerebral
409:
364:
1329:
take place in the left hemisphere, indicating that the NIHSS places more value on deficits in the
2333:
2249:
2121:
517:
1482:"Conjugate eye deviation in acute stroke: incidence, hemispheric asymmetry, and lesion pattern"
1379:
https://www.ninds.nih.gov/sites/default/files/documents/NIH-Stroke-Scale_updatedFeb2024_508.pdf
2388:
2325:
2290:
2241:
2203:
2162:
2113:
2077:
2042:
1987:
1946:
1911:
1867:
1813:
1778:
1737:
1701:
1657:
1618:
1583:
1548:
1503:
1460:
1027:
1023:
711:
Score should be recorded for each arm separately, resulting in a maximum potential score of 8.
631:
273:
199:
If patients scores a 3 in this factor, the default coma scores should be used when applicable
45:), is a tool used by healthcare providers to objectively quantify the impairment caused by a
2378:
2370:
2317:
2280:
2233:
2193:
2152:
2141:"A comparison of 5 stroke scales with measures of disability, handicap, and quality-of-life"
2105:
2069:
2032:
1977:
1938:
1901:
1857:
1805:
1768:
1729:
1691:
1649:
1610:
1601:
Goldstein LB, Bartels C, Davis JN (1989). "Interrater reliability of the NIH Stroke Scale".
1575:
1540:
1493:
1064:
Mild-to-moderate dysarthria; some slurring of speech, however the patient can be understood
627:
2357:
Martin-Schild S, Albright KC, Tanksley J, Pandav V, Jones EB, Grotta JC, Savitz SI (2011).
2021:"Modified National Institutes of Health Stroke Scale can be estimated from medical records"
1153:
Patient with severe vision loss that correctly identifies all other stimulations scores a 0
853:
Ataxia present in 2 or more limbs: rigid and inaccurate movement in both limbs on one side
509:
Complete hemianopia; patient recognizes no visual stimulus in one half of the visual field
171:
Not alert; Verbally arousable or aroused by minor stimulation to obey, answer, or respond.
2426:
1330:
1031:
727:
588:
1964:
Lyden PD, Lu M, Levine SR, Brott TG, Broderick J, NINDS rtPA Stroke Study Group. (2001).
1614:
1138:
Hemi-inattention; does not recognize stimuli in more than one modality on the same side.
1009:
Patients with visual loss should be asked to identify objects placed in his or her hands
444:
If patient is unable to follow any commands, assess the horizontal eye movement via the
2383:
2358:
2267:
Woo D, Broderick JP, Kothari RU, Lu M, Brott T, Lyden PD, Marler JR, Grotta JC (1999).
2198:
2181:
2037:
2020:
1906:
1889:
1498:
1481:
1351:
498:
2374:
2405:
372:
2337:
2269:"Does the National Institutes of Health Stroke Scale favor left hemisphere strokes?"
2253:
2125:
2019:
Kasner SE, Cucchiara BL, McGarvey ML, Luciano JM, Liebeskind DS, Chalela JA (2003).
1480:
Singer O, Humpich M, Laufs H, Lanfermann H, Steinmetz H, Neumann-Haefelin T (2006).
1356:
1189:
1181:
1448:
2237:
1862:
1845:
608:
572:
351:
208:
Patient is verbally asked his or her age and for the name of the current month.
17:
1809:
1176:
NIHSS has gained popularity as a clinical tool utilized in treatment planning.
1130:
Inattention on one side in one modality; visual, tactile, auditory, or spatial
2285:
2268:
2073:
1942:
1773:
1756:
813:
661:
No arm drift; the arm remains in the initial position for the full 10 seconds
494:
452:
281:
277:
2157:
2140:
1982:
1965:
1733:
1653:
747:
No leg drift; the leg remains in the initial position for the full 5 seconds
626:
Patients incapable of comprehending any commands may be tested by applying a
256:
The patient must answer each question 100% correct without help to get credit
1678:
Del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M (1998).
1579:
1544:
779:
No movement; patient has no ability to enact voluntary movement in this leg
693:
No movement; patient has no ability to enact voluntary movement in this arm
584:
520:
2392:
2329:
2294:
2245:
2207:
2117:
2046:
1991:
1950:
1915:
1871:
1817:
1782:
1741:
1661:
1507:
2166:
2081:
1705:
1696:
1679:
1622:
1587:
1552:
1428:
Hage V (2011). "The NIH stroke scale: a window into neurological status".
2321:
2109:
1185:
550:
794:
This is performed for each leg, indicating a maximum possible score of 8
455:
425:
413:
262:
1317:
1164:
868:
If patient is unable to understand commands or move limbs, score is 0
842:
266:
179:
Not alert; Only responsive to repeated or strong and painful stimuli
46:
269:
state who are unable to understand the commands receive a score of 2
187:
Totally unresponsive; Responds only with reflexes or is areflexic
1303:
The mNIHSS predicts patients at high risk of hemorrhage if given
501:; patient recognizes no visual stimulus in one specific quadrant
1324:
Effect of stroke location on NIHSS prediction of stroke severity
1212:
reason for declaring a patient as ineligible for tPA treatment.
611:, total paralysis in upper and lower portions of one face side
2180:
Weimar C, Konig I, Kraywinkel K, Ziegler A, Diener H (2004).
845:
present in 1 limb; rigid and inaccurate movement in one limb
1295:
Modified National Institutes of Health Stroke Scale (mNIHSS)
2226:
American Journal of Physical Medicine & Rehabilitation
630:
stimulus and observing for any paralysis in the resulting
587:; function is less than clearly normal, such as flattened
134:
ability to follow verbal commands to perform simple task.
871:
Patient's eyes should remain open throughout this section
2359:"Zero on the NIHSS does not equal the absence of stroke"
599:
Partial paralysis; particularly paralysis in lower face
259:
Patients unable to speak are allowed to write the answer
1184:, is one of the main options for treatment of acute
1844:Mishra, NK; Lyden, P; Grotta, JC; Lees, KR (2010).
396:Normal; Able to follow pen or finger to both sides
883:Sensory testing is performed via pinpricks in the
834:Normal coordination; smooth and accurate movement
2139:Dehaan R, Horn J, Limburg M, et al. (1993).
1888:Fink JN, Selim MH, Kumar S, et al. (2002).
1122:Normal; patient correctly answers all questions
367:opposite of injury. This item is tested because
1832:Journal of Clinical Pharmacy & Therapeutics
1092:11. Extinction and inattention (f.k.a. neglect)
797:Test the non paralyzed leg first if applicable
708:Test the non paralyzed arm first if applicable
874:If applicable, test the un-paretic side first
8:
2004:: CS1 maint: multiple names: authors list (
1449:"SLICE Worldwide 2021 - Failed Thrombectomy"
865:If significant weakness is present, score 0
2219:
2217:
241:Does not correctly answer either question
32:National Institutes of Health Stroke Scale
2382:
2284:
2197:
2156:
2036:
1981:
1905:
1861:
1772:
1695:
1497:
1673:
1671:
1634:
1632:
1223:
1107:
1041:
955:
890:
819:
732:
646:
556:
470:
381:
295:
272:Patients that are unable to talk due to
210:
148:
59:
2349:
1883:
1881:
1373:
1371:
1367:
326:Does not correctly perform either task
1997:
1458:
1423:
1421:
1419:
1417:
1337:NIHSS as predictor of patient outcomes
1447:Costalat, Doctor (13 October 2021) .
1415:
1413:
1411:
1409:
1407:
1405:
1403:
1401:
1399:
1397:
994:Unable to speak or understand speech
523:, including blindness from any cause
7:
1615:10.1001/archneur.1989.00520420080026
1204:/ American Stroke Association urge
338:Commands can only be repeated once.
2199:10.1161/01.str.0000106761.94985.8b
2038:10.1161/01.str.0000052630.11159.25
1907:10.1161/01.str.0000013069.24300.1d
1499:10.1161/01.str.0000244809.67376.10
970:Normal; no obvious speech deficit
25:
2375:10.1016/j.annemergmed.2010.06.564
225:Correctly answers both questions
1056:Normal; clear and smooth speech
812:This test for the presence of a
1208:NIHSS scores being used as the
233:Correctly answers one question
129:1. Level of consciousness (LOC)
310:Correctly performs both tasks
1:
2412:National Institutes of Health
1465:: CS1 maint: date and year (
416:, but cannot go past midline
2238:10.1097/phm.0b013e31813e0a32
1863:10.1161/strokeaha.110.589317
1834:December 2012;37(6):620-629.
1305:tissue plasminogen activator
1178:Tissue plasminogen activator
1172:NIHSS use in tPA eligibility
905:No evidence of sensory loss
591:or minor asymmetry in smile
451:If the patient has isolated
428:; gaze is fixed to one side
1346:Other stroke-related scores
1272:Extinction and inattention
2443:
1810:10.1001/archneurol.2007.12
1202:American Heart Association
359:2. Horizontal eye movement
318:Correctly performs 1 task
265:patients or patients in a
98:Moderate to severe stroke
2286:10.1161/01.str.30.11.2355
2074:10.1161/01.str.27.10.1817
1943:10.1161/01.str.30.11.2347
1774:10.1161/01.str.30.12.2598
2158:10.1161/01.str.24.8.1178
1983:10.1161/01.str.32.6.1310
1734:10.1001/jama.282.21.2003
1654:10.1001/jama.282.21.2019
1244:Horizontal eye movement
726:With the patient in the
369:conjugated eye deviation
1580:10.1161/01.str.20.7.864
1545:10.1161/01.str.30.1.109
280:, language barrier, or
2422:Medical scoring system
446:oculocephalic maneuver
377:temporoparietal cortex
350:Patients with trauma,
284:are given a score of 1
27:Medical scoring system
1798:Archives of Neurology
1697:10.1161/01.str.29.1.4
1150:Default coma score: 2
1006:Default coma score: 3
933:Default coma score: 2
791:Default coma score: 8
705:Default coma score: 8
253:Default Coma Score: 2
141:A) LOC responsiveness
2417:Diagnostic neurology
2322:10.1212/wnl.53.1.126
2110:10.1212/wnl.55.7.952
1453:Master & Fellows
1084:Default coma score:2
463:3. Visual field test
113:Performing the scale
458:assign a score of 1
74:No stroke symptoms
1036:anterior cingulate
1024:anterior opercular
163:Alert; Responsive
2279:(11): 2355–2359.
2068:(10): 1817–1820.
1937:(11): 2347–2354.
1767:(12): 2598–2605.
1728:(21): 2003–2011.
1648:(21): 2019–2026.
1492:(11): 2726–2732.
1292:
1291:
1180:(tPA), a type of
1142:
1141:
1076:
1075:
1028:medial prefrontal
998:
997:
925:
924:
857:
856:
783:
782:
697:
696:
615:
614:
527:
526:
432:
431:
330:
329:
245:
244:
191:
190:
110:
109:
16:(Redirected from
2434:
2397:
2396:
2386:
2354:
2342:
2341:
2305:
2299:
2298:
2288:
2264:
2258:
2257:
2221:
2212:
2211:
2201:
2177:
2171:
2170:
2160:
2136:
2130:
2129:
2092:
2086:
2085:
2057:
2051:
2050:
2040:
2016:
2010:
2009:
2003:
1995:
1985:
1961:
1955:
1954:
1926:
1920:
1919:
1909:
1885:
1876:
1875:
1865:
1856:(6): 2612–2617.
1841:
1835:
1828:
1822:
1821:
1793:
1787:
1786:
1776:
1752:
1746:
1745:
1716:
1710:
1709:
1699:
1675:
1666:
1665:
1636:
1627:
1626:
1598:
1592:
1591:
1563:
1557:
1556:
1528:
1522:
1518:
1512:
1511:
1501:
1477:
1471:
1470:
1464:
1456:
1444:
1438:
1437:
1430:Nursing Spectrum
1425:
1392:
1388:
1382:
1375:
1247:Right arm motor
1224:
1108:
1042:
956:
891:
820:
733:
647:
607:Complete facial
557:
471:
453:peripheral nerve
382:
296:
211:
204:B) LOC questions
149:
90:Moderate stroke
66:Stroke severity
60:
21:
18:NIH stroke scale
2442:
2441:
2437:
2436:
2435:
2433:
2432:
2431:
2402:
2401:
2400:
2356:
2355:
2351:
2345:
2307:
2306:
2302:
2266:
2265:
2261:
2223:
2222:
2215:
2179:
2178:
2174:
2138:
2137:
2133:
2094:
2093:
2089:
2059:
2058:
2054:
2018:
2017:
2013:
1996:
1963:
1962:
1958:
1928:
1927:
1923:
1887:
1886:
1879:
1843:
1842:
1838:
1829:
1825:
1795:
1794:
1790:
1754:
1753:
1749:
1718:
1717:
1713:
1677:
1676:
1669:
1638:
1637:
1630:
1600:
1599:
1595:
1565:
1564:
1560:
1530:
1529:
1525:
1519:
1515:
1479:
1478:
1474:
1457:
1446:
1445:
1441:
1427:
1426:
1395:
1389:
1385:
1376:
1369:
1365:
1348:
1339:
1331:left hemisphere
1326:
1313:
1297:
1250:Left arm motor
1230:Right cortical
1218:
1216:NIHSS structure
1174:
1165:stroke symptoms
1160:
1094:
1019:
946:
881:
810:
728:supine position
724:
641:
589:nasolabial fold
546:
544:4. Facial palsy
485:No vision loss
465:
361:
291:
289:C) LOC commands
206:
143:
131:
115:
28:
23:
22:
15:
12:
11:
5:
2440:
2438:
2430:
2429:
2424:
2419:
2414:
2404:
2403:
2399:
2398:
2348:
2344:
2343:
2316:(1): 126–131.
2300:
2259:
2232:(9): 725–733.
2213:
2192:(1): 158–162.
2172:
2151:(8): 1178–81.
2131:
2104:(7): 952–959.
2087:
2052:
2011:
1956:
1921:
1877:
1836:
1823:
1788:
1747:
1711:
1667:
1628:
1609:(6): 660–662.
1593:
1558:
1539:(1): 109–113.
1523:
1513:
1472:
1439:
1393:
1383:
1366:
1364:
1361:
1360:
1359:
1354:
1347:
1344:
1338:
1335:
1325:
1322:
1312:
1309:
1296:
1293:
1290:
1289:
1287:
1285:
1282:
1279:
1278:
1276:
1273:
1270:
1266:
1265:
1262:
1259:
1258:Visual fields
1256:
1252:
1251:
1248:
1245:
1242:
1241:LOC questions
1238:
1237:
1234:
1231:
1228:
1227:Left cortical
1217:
1214:
1173:
1170:
1159:
1156:
1155:
1154:
1151:
1140:
1139:
1136:
1132:
1131:
1128:
1124:
1123:
1120:
1116:
1115:
1112:
1093:
1090:
1089:
1088:
1085:
1074:
1073:
1070:
1066:
1065:
1062:
1058:
1057:
1054:
1050:
1049:
1046:
1018:
1015:
1014:
1013:
1010:
1007:
996:
995:
992:
988:
987:
984:
980:
979:
976:
972:
971:
968:
964:
963:
960:
945:
942:
941:
940:
937:
934:
923:
922:
919:
915:
914:
911:
907:
906:
903:
899:
898:
895:
880:
877:
876:
875:
872:
869:
866:
855:
854:
851:
847:
846:
840:
836:
835:
832:
828:
827:
824:
809:
808:7. Limb ataxia
806:
805:
804:
801:
798:
795:
792:
781:
780:
777:
773:
772:
769:
765:
764:
761:
757:
756:
753:
749:
748:
745:
741:
740:
737:
723:
720:
719:
718:
715:
712:
709:
706:
695:
694:
691:
687:
686:
683:
679:
678:
675:
671:
670:
667:
663:
662:
659:
655:
654:
651:
640:
637:
636:
635:
624:
613:
612:
605:
601:
600:
597:
593:
592:
581:
577:
576:
569:
565:
564:
561:
545:
542:
541:
540:
536:
525:
524:
515:
511:
510:
507:
503:
502:
499:quadrantanopia
491:
487:
486:
483:
479:
478:
475:
464:
461:
460:
459:
449:
442:
430:
429:
422:
418:
417:
402:
398:
397:
394:
390:
389:
386:
360:
357:
356:
355:
348:
345:
342:
339:
328:
327:
324:
320:
319:
316:
312:
311:
308:
304:
303:
300:
290:
287:
286:
285:
270:
260:
257:
254:
243:
242:
239:
235:
234:
231:
227:
226:
223:
219:
218:
215:
205:
202:
201:
200:
189:
188:
185:
181:
180:
177:
173:
172:
169:
165:
164:
161:
157:
156:
153:
142:
139:
130:
127:
114:
111:
108:
107:
106:Severe stroke
104:
100:
99:
96:
92:
91:
88:
84:
83:
80:
76:
75:
72:
68:
67:
64:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
2439:
2428:
2425:
2423:
2420:
2418:
2415:
2413:
2410:
2409:
2407:
2394:
2390:
2385:
2380:
2376:
2372:
2368:
2364:
2363:Ann Emerg Med
2360:
2353:
2350:
2347:
2339:
2335:
2331:
2327:
2323:
2319:
2315:
2311:
2304:
2301:
2296:
2292:
2287:
2282:
2278:
2274:
2270:
2263:
2260:
2255:
2251:
2247:
2243:
2239:
2235:
2231:
2227:
2220:
2218:
2214:
2209:
2205:
2200:
2195:
2191:
2187:
2183:
2176:
2173:
2168:
2164:
2159:
2154:
2150:
2146:
2142:
2135:
2132:
2127:
2123:
2119:
2115:
2111:
2107:
2103:
2099:
2091:
2088:
2083:
2079:
2075:
2071:
2067:
2063:
2056:
2053:
2048:
2044:
2039:
2034:
2031:(2): 568–70.
2030:
2026:
2022:
2015:
2012:
2007:
2001:
1993:
1989:
1984:
1979:
1976:(6): 1310–7.
1975:
1971:
1967:
1960:
1957:
1952:
1948:
1944:
1940:
1936:
1932:
1925:
1922:
1917:
1913:
1908:
1903:
1899:
1895:
1891:
1884:
1882:
1878:
1873:
1869:
1864:
1859:
1855:
1851:
1847:
1840:
1837:
1833:
1827:
1824:
1819:
1815:
1811:
1807:
1803:
1799:
1792:
1789:
1784:
1780:
1775:
1770:
1766:
1762:
1758:
1751:
1748:
1743:
1739:
1735:
1731:
1727:
1723:
1715:
1712:
1707:
1703:
1698:
1693:
1689:
1685:
1681:
1674:
1672:
1668:
1663:
1659:
1655:
1651:
1647:
1643:
1635:
1633:
1629:
1624:
1620:
1616:
1612:
1608:
1604:
1597:
1594:
1589:
1585:
1581:
1577:
1574:(7): 864–70.
1573:
1569:
1562:
1559:
1554:
1550:
1546:
1542:
1538:
1534:
1527:
1524:
1517:
1514:
1509:
1505:
1500:
1495:
1491:
1487:
1483:
1476:
1473:
1468:
1462:
1454:
1450:
1443:
1440:
1435:
1431:
1424:
1422:
1420:
1418:
1416:
1414:
1412:
1410:
1408:
1406:
1404:
1402:
1400:
1398:
1394:
1387:
1384:
1380:
1374:
1372:
1368:
1362:
1358:
1355:
1353:
1350:
1349:
1345:
1343:
1336:
1334:
1332:
1323:
1321:
1319:
1310:
1308:
1306:
1301:
1294:
1288:
1286:
1283:
1281:
1280:
1277:
1274:
1271:
1268:
1267:
1263:
1260:
1257:
1255:LOC commands
1254:
1253:
1249:
1246:
1243:
1240:
1239:
1235:
1232:
1229:
1226:
1225:
1222:
1215:
1213:
1211:
1207:
1203:
1197:
1193:
1191:
1187:
1183:
1179:
1171:
1169:
1166:
1157:
1152:
1149:
1148:
1147:
1146:
1137:
1134:
1133:
1129:
1126:
1125:
1121:
1118:
1117:
1114:Test results
1113:
1110:
1109:
1106:
1102:
1098:
1091:
1086:
1083:
1082:
1081:
1080:
1071:
1068:
1067:
1063:
1060:
1059:
1055:
1052:
1051:
1048:Test results
1047:
1044:
1043:
1040:
1037:
1033:
1029:
1025:
1016:
1011:
1008:
1005:
1004:
1003:
1002:
993:
990:
989:
985:
982:
981:
977:
974:
973:
969:
966:
965:
962:Test results
961:
958:
957:
954:
950:
943:
938:
935:
932:
931:
930:
929:
920:
917:
916:
912:
909:
908:
904:
901:
900:
897:Test results
896:
893:
892:
889:
886:
878:
873:
870:
867:
864:
863:
862:
861:
852:
849:
848:
844:
841:
838:
837:
833:
830:
829:
826:Test results
825:
822:
821:
818:
815:
807:
802:
799:
796:
793:
790:
789:
788:
787:
778:
775:
774:
770:
767:
766:
762:
759:
758:
754:
751:
750:
746:
743:
742:
739:Test results
738:
735:
734:
731:
729:
721:
716:
713:
710:
707:
704:
703:
702:
701:
692:
689:
688:
684:
681:
680:
676:
673:
672:
668:
665:
664:
660:
657:
656:
653:Test results
652:
649:
648:
645:
638:
633:
629:
625:
622:
621:
620:
619:
610:
606:
603:
602:
598:
595:
594:
590:
586:
582:
579:
578:
574:
570:
567:
566:
563:Test results
562:
559:
558:
555:
552:
543:
537:
534:
533:
532:
531:
522:
519:
516:
513:
512:
508:
505:
504:
500:
496:
492:
489:
488:
484:
481:
480:
477:Test results
476:
473:
472:
469:
462:
457:
454:
450:
447:
443:
439:
438:
437:
436:
427:
423:
420:
419:
415:
411:
407:
403:
400:
399:
395:
392:
391:
388:Test results
387:
384:
383:
380:
378:
374:
373:basal ganglia
370:
366:
358:
353:
349:
346:
343:
340:
337:
336:
335:
334:
325:
322:
321:
317:
314:
313:
309:
306:
305:
302:Test results
301:
298:
297:
294:
288:
283:
279:
275:
271:
268:
264:
261:
258:
255:
252:
251:
250:
249:
240:
237:
236:
232:
229:
228:
224:
221:
220:
217:Test results
216:
213:
212:
209:
203:
198:
197:
196:
195:
186:
183:
182:
178:
175:
174:
170:
167:
166:
162:
159:
158:
155:Test results
154:
151:
150:
147:
140:
138:
135:
128:
126:
123:
119:
112:
105:
102:
101:
97:
94:
93:
89:
86:
85:
82:Minor stroke
81:
78:
77:
73:
70:
69:
65:
62:
61:
58:
55:
51:
48:
44:
40:
38:
33:
19:
2366:
2362:
2352:
2346:
2313:
2309:
2303:
2276:
2272:
2262:
2229:
2225:
2189:
2185:
2175:
2148:
2144:
2134:
2101:
2097:
2090:
2065:
2061:
2055:
2028:
2024:
2014:
2000:cite journal
1973:
1969:
1959:
1934:
1930:
1924:
1900:(4): 954–8.
1897:
1893:
1853:
1849:
1839:
1831:
1826:
1804:(1): 39–43.
1801:
1797:
1791:
1764:
1760:
1750:
1725:
1721:
1714:
1687:
1683:
1645:
1641:
1606:
1602:
1596:
1571:
1567:
1561:
1536:
1532:
1526:
1516:
1489:
1485:
1475:
1452:
1442:
1436:(15): 44–49.
1433:
1429:
1386:
1357:CHADS2 score
1340:
1327:
1314:
1302:
1298:
1233:Right motor
1219:
1209:
1205:
1198:
1194:
1182:thrombolysis
1175:
1161:
1144:
1143:
1103:
1099:
1095:
1078:
1077:
1020:
1000:
999:
951:
947:
927:
926:
882:
859:
858:
811:
785:
784:
725:
722:6. Motor leg
699:
698:
642:
639:5. Motor arm
617:
616:
547:
529:
528:
497:or complete
466:
434:
433:
362:
332:
331:
292:
247:
246:
207:
193:
192:
144:
136:
132:
124:
120:
116:
56:
52:
42:
39:Stroke Scale
35:
31:
29:
2369:(1): 42–5.
1690:(1): 4–11.
1603:Arch Neurol
1352:ABCD² score
1275:Dysarthria
1236:Left motor
944:9. Language
609:Hemiparesis
573:symmetrical
571:Normal and
424:Total gaze
352:amputations
2406:Categories
1363:References
1261:Right leg
1017:10. Speech
879:8. Sensory
814:unilateral
539:movement).
495:hemianopia
410:hemisphere
406:gaze palsy
365:hemisphere
282:intubation
278:dysarthria
2310:Neurology
2098:Neurology
1269:Language
1264:Left leg
585:paralysis
575:movement
521:Blindness
518:Bilateral
267:stuporous
2393:20828876
2338:20176582
2330:10408548
2295:10548670
2254:29378035
2246:17709996
2208:14684776
2126:39939549
2118:11061250
2047:12574577
1992:11387492
1951:10548669
1916:11935043
1872:20947852
1818:18195138
1783:10582984
1742:10591382
1662:10591384
1508:17008621
1461:cite web
1320:volume.
1311:Accuracy
1284:Sensory
1186:ischemic
1032:premotor
885:proximal
551:symmetry
493:Partial
441:contact.
404:Partial
2384:3426834
2167:8342193
2082:8841337
1706:9445320
1623:2730378
1588:2749846
1553:9880397
1206:against
632:grimace
628:noxious
456:paresis
426:paresis
414:infarct
263:Aphasic
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2427:Stroke
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1970:Stroke
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1318:lesion
1190:artery
1111:Score
1045:Score
1034:, and
959:Score
894:Score
843:Ataxia
823:Score
736:Score
650:Score
583:Minor
560:Score
474:Score
385:Score
299:Score
274:trauma
214:Score
152:Score
103:21–42
95:16–20
47:stroke
2334:S2CID
2250:S2CID
2122:S2CID
1158:Usage
1145:Notes
1079:Notes
1001:Notes
928:Notes
860:Notes
786:Notes
700:Notes
618:Notes
530:Notes
435:Notes
333:Notes
248:Notes
194:Notes
87:5–15
43:NIHSS
34:, or
2389:PMID
2326:PMID
2291:PMID
2242:PMID
2204:PMID
2163:PMID
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2078:PMID
2043:PMID
2006:link
1988:PMID
1947:PMID
1912:PMID
1868:PMID
1814:PMID
1779:PMID
1738:PMID
1722:JAMA
1702:PMID
1658:PMID
1642:JAMA
1619:PMID
1584:PMID
1549:PMID
1521:10p.
1504:PMID
1467:link
1210:sole
1030:and
375:and
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2371:doi
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1978:doi
1939:doi
1902:doi
1858:doi
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1769:doi
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