NIHSS

NIH Stroke Scale — score each item from the standard scale; total 0–42

1a. Level of consciousness

0 — Alert

1 — Not alert, rousable by minor stimulation

2 — Not alert, needs repeated or painful stimulation

3 — Unresponsive / reflex responses only

1b. LOC questions (month, age)

0 — Both answered correctly

1 — One answered correctly

2 — Neither answered correctly

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

0 — Both tasks performed

1 — One task performed

2 — Neither task performed

2. Best gaze

0 — Normal

1 — Partial gaze palsy

2 — Forced deviation

3. Visual fields

0 — No visual loss

1 — Partial hemianopia

2 — Complete hemianopia

3 — Bilateral hemianopia / blindness

4. Facial palsy

0 — Normal symmetrical movement

1 — Minor paralysis (flattened nasolabial fold)

2 — Partial paralysis (lower face)

3 — Complete paralysis (upper and lower face)

5a. Left arm motor

0 — No drift for 10 s

1 — Drift but does not hit bed

2 — Some effort against gravity

3 — No effort against gravity

4 — No movement

5b. Right arm motor

0 — No drift for 10 s

1 — Drift but does not hit bed

2 — Some effort against gravity

3 — No effort against gravity

4 — No movement

6a. Left leg motor

0 — No drift for 5 s

1 — Drift but does not hit bed

2 — Some effort against gravity

3 — No effort against gravity

4 — No movement

6b. Right leg motor

0 — No drift for 5 s

1 — Drift but does not hit bed

2 — Some effort against gravity

3 — No effort against gravity

4 — No movement

7. Limb ataxia

0 — Absent

1 — Present in one limb

2 — Present in two limbs

8. Sensory

0 — Normal

1 — Mild-to-moderate loss

2 — Severe or 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 slurring

2 — Severe / unintelligible or mute

11. Extinction and inattention

0 — No abnormality

1 — Inattention in one modality

2 — Profound hemi-inattention / multiple modalities

Evidence

Original publication

Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Introduced the 15-item NIH Stroke Scale (level of consciousness, gaze, fields, facial and limb motor, ataxia, sensation, language, dysarthria, extinction); reproducible between examiners and correlated with infarct volume.

Stroke, 1989

Open source

Validation

Adams HP Jr, Davis PH, Leira EC, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke (TOAST). Each additional point reduced the odds of an excellent 3-month outcome by ~17%; scores > 15–20 predicted death or severe disability.

Neurology, 1999

Open source

Guideline

The 2019 AHA/ASA acute ischaemic stroke guideline recommends the NIHSS as the standard baseline severity scale and uses it in reperfusion decision-making.

Last reviewed: 2026-09

Report an error in this calculator

MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.