NIHSS (Stroke Severity) — JoyShine Medical

NIHSS (National Institutes of Health Stroke Scale)

15-item bedside scale quantifying acute stroke severity to support thrombolytic/endovascular decisions, prognosis, and serial monitoring; this simplified version accepts only numeric scores and does not implement the official untestable (UN) codes, so interpret partial scores accordingly.

1a. Level of consciousness (LOC)

0 - Alert 1 - Drowsy (rousable by minor stimulation) 2 - Stuporous (requires repeated or strong stimulation) 3 - Unresponsive / reflex motor only

1b. LOC questions (current month, age)

0 - Both correct 1 - One correct 2 - Both incorrect / unable

1c. LOC commands (open / close eyes, grip / release hand)

0 - Both performed correctly 1 - One performed correctly 2 - Neither performed

2. Best gaze

0 - Normal horizontal eye movements 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 / blindness

4. Facial palsy

0 - Normal symmetric 1 - Minor (flattened nasolabial fold) 2 - Partial (= total / near-total lower face paralysis) 3 - Complete (upper + lower face)

5a. Motor — Left arm (extend at 90° sitting, 45° supine, hold 10 s)

0 - No drift 1 - Drift before 10 s, no touch 2 - Some effort against gravity, hits bed 3 - No effort against gravity 4 - No movement

5b. Motor — Right arm (same protocol)

0 - No drift 1 - Drift before 10 s, no touch 2 - Some effort against gravity, hits bed 3 - No effort against gravity 4 - No movement

6a. Motor — Left leg (supine, 30°, hold 5 s)

0 - No drift 1 - Drift 2 - Some effort, hits bed 3 - No effort against gravity 4 - No movement

6b. Motor — Right leg (same protocol)

0 - No drift 1 - Drift 2 - Some effort, hits bed 3 - No effort against gravity 4 - No movement

7. Limb ataxia (finger-nose, heel-shin)

0 - Absent 1 - In one limb 2 - In two limbs

8. Sensory (pinprick)

0 - Normal 1 - Mild-to-moderate loss 2 - Severe / total loss

9. Best language

0 - No aphasia 1 - Mild-to-moderate aphasia 2 - Severe aphasia 3 - Mute / global aphasia

10. Dysarthria

0 - Normal 1 - Mild-to-moderate (slurs some words) 2 - Severe (= unintelligible / mute / anarthric)

11. Extinction and inattention (neglect)

0 - No abnormality 1 - Visual / tactile / auditory / spatial inattention to one modality 2 - Profound hemi-inattention (more than one modality)