Neurology Guidelines: The National Institutes of Health Stroke Scale (NIHSS) quantifies acute stroke impairment across 15 neurological examination items (scored 0 to 42 max). Select patient exam findings below.
NIHSS Examination Parameters Input
1a. Level of Consciousness (LOC)
0 – Alert; keenly responsive 1 – Not alert; arousable by minor stimulation 2 – Not alert; requires repeated stimulation to attend 3 – Unresponsive or responds only with reflex pain
1b. LOC Questions (Month & Age)
0 – Answers both correctly 1 – Answers one correctly 2 – Answers neither correctly
1c. LOC Commands (Open/close eyes & grip)
0 – Performs both tasks correctly 1 – Performs one task correctly 2 – Performs neither task correctly
2. Best Gaze
0 – Normal 1 – Partial gaze palsy 2 – Forced deviation or total gaze paresis
3. Visual Fields
0 – No visual loss 1 – Partial hemianopia 2 – Complete hemianopia 3 – Bilateral hemianopia (blind)
4. Facial Palsy
0 – Normal symmetric movements 1 – Minor paralysis (flattened nasolabial fold) 2 – Partial paralysis (lower face) 3 – Complete paralysis of one or both sides
5a. Motor - Left Arm
0 – No drift (holds 10 seconds) 1 – Drift (holds, but drifts down before 10s) 2 – Cannot resist gravity (falls to bed) 3 – No effort against gravity (slips/falls) 4 – No movement / amputation
5b. Motor - Right Arm
0 – No drift (holds 10 seconds) 1 – Drift (holds, but drifts down before 10s) 2 – Cannot resist gravity (falls to bed) 3 – No effort against gravity (slips/falls) 4 – No movement / amputation
6a. Motor - Left Leg
0 – No drift (holds 5 seconds) 1 – Drift (falls by end of 5s) 2 – Cannot resist gravity (falls in < 5s) 3 – No effort against gravity 4 – No movement / amputation
6b. Motor - Right Leg
0 – No drift (holds 5 seconds) 1 – Drift (falls by end of 5s) 2 – Cannot resist gravity (falls in < 5s) 3 – No effort against gravity 4 – No movement / amputation
7. Limb Ataxia
0 – Absent / does not apply 1 – Present in one limb 2 – Present in two or more limbs
8. Sensory
0 – Normal; no sensory loss 1 – Mild-to-moderate sensory loss 2 – Severe to total sensory loss
9. Best Language (Aphasia)
0 – No aphasia; normal 1 – Mild-to-moderate aphasia 2 – Severe aphasia 3 – Mute, global aphasia
10. Dysarthria
0 – Normal articulation 1 – Mild-to-moderate slurring 2 – Severe slurring / unintelligible
11. Extinction and Inattention (Neglect)
0 – No neglect 1 – Visual, tactile, auditory, spatial, or personal inattention 2 – Profound hemineglect in more than one modality
Calculate NIHSS Score ⚠️ Not medical advice. For neurology, emergency medicine, and clinical reference only. Acute stroke assessment, triage, and thrombolytic or endovascular treatment decisions must be supervised strictly by a qualified neurologist or emergency physician.
