National Institute Of Health Stroke Scale (NIHSS) Neurology Department Ibn-e-Siena Hospital and Research Institute Multan
Patient Follow-ups Post Stroke Follow-ups Days Score
Patient History & Examination Examination Findings Significant Examination Findings
Scale 1a. Level of Consciousness:* 1b. LOC Questions:* Questions are:
1- What's your age?
2- What is the month?
1c. LOC Commands:* Commands are:
1- Open close your eyes
2- Grip and release your hard
2. Best Gaze: Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye movements will be scored,
but caloric testing is not done. If the patient has a conjugate
deviation of the eyes that can be overcome by voluntary or reflexive
activity, the score will be 1. If a patient has an isolated peripheral
nerve paresis (CN III, IV or VI), score a 1. Gaze is testable in all
aphasic patients. Patients with ocular trauma, bandages, pre-existing
blindness, or other disorder of visual acuity or fields should be tested
with reflexive movements, and a choice made by the investigator.
Establishing eye contact and then moving about the patient from side
to side will occasionally clarify the presence of a partial gaze palsy.
3. Visual:* Visual fields (upper and lower quadrants) are tested by
confrontation, using finger counting or visual threat, as appropriate.
Patients may be encouraged, but if they look at the side of the
moving fingers appropriately, this can be scored as normal. If there is
unilateral blindness or enucleation, visual fields in the remaining eye
are scored. Score 1 only if a clear-cut asymmetry, including
quadrantanopia, is found. If patient is blind from any cause, score 3.
Double simultaneous stimulation is performed at this point. If there is
extinction, patient receives a 1, and the results are used to respond to
item 11.
4. Facial Palsy:* Ask – or use pantomime to encourage – the patient
to show teeth or raise eyebrows and close eyes. Score symmetry of
grimace in response to noxious stimuli in the poorly responsive or
non-comprehending patient. If facial trauma/bandages, orotracheal
tube, tape or other physical barriers obscure the face, these should
be removed to the extent possible.
5. Motor Arm:* The limb is placed in the appropriate position: extend
the arms (palms down) 90 degrees (if sitting) or 45 degrees (if
supine). Drift is scored if the arm falls before 10 seconds. The
aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn,
beginning with the non-paretic arm. Only in the case of amputation or
joint fusion at the shoulder, the examiner should record the score as
untestable (UN), and clearly write the explanation for this choice.
6. Motor Leg:* The limb is placed in the appropriate position: hold
the leg at 30 degrees (always tested supine). Drift is scored if the leg
falls before 5 seconds. The aphasic patient is encouraged using
urgency in the voice and pantomime, but not noxious stimulation.
Each limb is tested in turn, beginning with the non-paretic leg. Only
in the case of amputation or joint fusion at the hip, the examiner
should record the score as untestable (UN), and clearly write the
explanation for this choice.
7. Limb Ataxia:* This item is aimed at finding evidence of a unilateral
cerebellar lesion. Test with eyes open. In case of visual defect,
ensure testing is done in intact visual field. The finger-nose-finger
and heel-shin tests are performed on both sides, and ataxia is scored
only if present out of proportion to weakness. Ataxia is absent in the
patient who cannot understand or is paralyzed. Only in the case of
amputation or joint fusion, the examiner should record the score as
untestable (UN), and clearly write the explanation for this choice. In
case of blindness, test by having the patient touch nose from
extended arm position.
8. Sensory:* Sensation or grimace to pinprick when tested, or
withdrawal from noxious stimulus in the obtunded or aphasic patient.
Only sensory loss attributed to stroke is scored as abnormal and the
examiner should test as many body areas (arms [not hands], legs,
trunk, face) as needed to accurately check for hemisensory loss. A
score of 2, “severe or total sensory loss,” should only be given when
a severe or total loss of sensation can be clearly demonstrated.
Stuporous and aphasic patients will, therefore, probably score 1 or 0.
The patient with brainstem stroke who has bilateral loss of sensation
is scored 2. If the patient does not respond and is quadriplegic, score
2. Patients in a coma (item 1a=3) are automatically given a 2 on this
item.
9. Best Language:* A great deal of information about comprehension
will be obtained during the preceding sections of the examination.
For this scale item, the patient is asked to describe what is happening
in the attached picture, to name the items on the attached naming
sheet and to read from the attached list of sentences.
Comprehension is judged from responses here, as well as to all of
the commands in the preceding general neurological exam. If visual
loss interferes with the tests, ask the patient to identify objects placed
in the hand, repeat, and produce speech. The intubated patient
should be asked to write. The patient in a coma (item 1a=3) will
automatically score 3 on this item. The examiner must choose a
score for the patient with stupor or limited cooperation, but a score of
3 should be used only if the patient is mute and follows no one-step
commands.
10. Dysarthria:* If patient is thought to be normal, an adequate
sample of speech must be obtained by asking patient to read or
repeat words from the attached list. If the patient has severe
aphasia, the clarity of articulation of spontaneous speech can be
rated. Only if the patient is intubated or has other physical barriers to
producing speech, the examiner should record the score as
untestable (UN), and clearly write an explanation for this choice. Do
not tell the patient why he or she is being tested.
11. Extinction and Inattention (formerly Neglect):* Sufficient
information to identify neglect may be obtained during the prior
testing. If the patient has a severe visual loss preventing visual
double simultaneous stimulation, and the cutaneous stimuli are
normal, the score is normal. If the patient has aphasia but does
appear to attend to both sides, the score is normal. The presence of
visual spatial neglect or anosagnosia may also be taken as evidence
of abnormality. Since the abnormality is scored only if present, the
item is never untestable
NIHSS Score Stroke Severity* NIHSS Score 0-42, 0 = No Stroke, 1-4 = Minor Stroke, 5-15 = Moderate Stroke, 16-20 = Moderate to Severe Stroke, 21-40 = Severe Stroke
1 month Mortality %* NIHSS Score 0-42, 0 = No Stroke, 1-4 = Minor Stroke, 5-15 = Moderate Stroke, 16-20 = Moderate to Severe Stroke, 21-40 = Severe Stroke
Recovery in 90 Days % NIHSS Score 0-42, 0 = No Stroke, 1-4 = Minor Stroke, 5-15 = Moderate Stroke, 16-20 = Moderate to Severe Stroke, 21-40 = Severe Stroke
Bamford Stroke Classification TACS= Total anterior circulation, PACS= Partial anterior circulation, LACS= Lacunar stroke, POCS = Posterior circulation
Consent Form Consent Form/ اجازت نامہ .میں ریسرچ کے لئے اجازت دیتا/دیتی ہوں
میں________ میڈیکل ریزروچ کے مقصد اپنا میڈیکل ریکارڈ اور رابطہ نمبر شیئر کرنے کی اجازت دیتا/دیتی ہوں مجھے اس عمل کے بارے میں بتایا گیا ہے اور مجھے یہ بھی بتایا گیا ہے . میرا ڈیٹا صرف اس مقصد کے لیے استعمال کیا جائے گا اور اسے خفیہ رکھا جائے گا۔
Signature of Pt./Relative