|
1a. LOC |
0 |
Alert | |
|
1 |
Drowsy | ||
|
2 |
Stuporous | ||
|
3 |
Comatose | ||
|
1b. LOC questions |
0 |
Answers both questions correctly | |
|
1 |
Answers 1 question correctly | ||
|
2 |
Answers neither question correctly | ||
|
1c. LOC commands |
0 |
Performs both tasks correctly | |
|
1 |
Performs 1 task correctly | ||
|
2 |
Performs neither task correctly | ||
|
2. Best gaze |
0 |
Normal | |
|
1 |
Partial gaze palsy | ||
|
2 |
Forced deviation | ||
|
3. Visual fields |
0 |
No visual loss (or in coma) | |
|
1 |
Partial hemianopia | ||
|
2 |
Complete hemianopia | ||
|
3 |
Bilateral hemianopia | ||
|
4. Facial palsy |
0 |
Normal | |
|
1 |
Minor | ||
|
2 |
Partial | ||
|
3 |
Complete | ||
|
5. Best motor: right arm |
0 |
No drift | |
|
1 |
Drift | ||
|
2 |
Some effort against gravity | ||
|
3 |
No effort against gravity | ||
|
4 |
No movement | ||
|
6. Best motor: left arm |
0 |
No drift | |
|
1 |
Drift | ||
|
2 |
Some effort against gravity | ||
|
3 |
No effort against gravity | ||
|
4 |
No movement | ||
|
7. Best motor: right leg |
0 |
No drift | |
|
1 |
Drift | ||
|
2 |
Some effort against gravity | ||
|
3 |
No effort against gravity | ||
|
4 |
No movement | ||
|
8. Best motor: left leg |
0 |
No drift | |
|
1 |
Drift | ||
|
2 |
Some effort against gravity | ||
|
3 |
No effort against gravity | ||
|
4 |
No movement | ||
|
9. Limb ataxia |
0 |
Absent (or in coma) | |
|
1 |
Present in 1 limb | ||
|
2 |
Present in ≥2 limbs | ||
|
10. Sensory |
0 |
Normal | |
|
1 |
Partial loss | ||
|
2 |
Dense loss (or in coma) | ||
|
11. Best language |
0 |
No dysphasia | |
|
1 |
Mild | ||
|
2 |
Severe dysphasia | ||
|
3 |
Mute | ||
|
12. Dysarthria |
0 |
Normal articulation | |
|
1 |
Mild to moderate dysarthria | ||
|
2 |
Unintelligible or worse | ||
|
13. Neglect |
0 |
No neglect (or in coma) | |
|
1 |
Partial neglect | ||
|
2 |
Complete neglect | ||
|
NIHSS total score |
|||
|
NIHSS scoring for aphasic and comatose patients: 1b. LOC questions: Aphasic and stuporous patients unable to state age or month = 2 points. 2. Best gaze: Conjugate gaze deviation overcome by voluntary or reflex movement = 1 point. Isolated eye nerve palsy = 1 point. 3. Visual fields: Visual field clear cut asymmetry = 1 point. Total blindness = 2 points. 4. Facial palsy: Facial asymmetry can be assessed in response to noxious stimuli. 5-8. Motor testing: Motor testing can be pantomimed for aphasic patients. 9. Limb ataxia: If cannot be demonstrated = 0 points. 10. Sensory: Asymmetry = 1 point. Bilateral sensory loss = 2 points. Patient in coma and with no response to pain = 2 points. 11. Best language: Patient in coma = 3 points. 12. Dysarthria: Scored only if audible speech is heard. 13. Neglect: Present if obviously more than blindness or sensory loss. | |||
|
LOC, level of consciousness; NIHSS, National Institute of Health Stroke Scale. | |||