The National Institutes of Health Stroke Scale*
Criterion | Finding | Score | |||
|---|---|---|---|---|---|
Level of consciousness (LOC) | Alert, keenly responsive | 0 | |||
Not alert, but can be aroused using minor stimulation to obey, answer, or respond | 1 | ||||
Not alert; requires repeated stimulation to attend or is obtunded and requires strong or painful stimulation to make purposeful movements | 2 | ||||
Responds only with reflex motor or autonomic effects or is totally unresponsive, flaccid, and areflexic | 3 | ||||
LOC questions† | Answers both correctly | 0 | |||
Answers one correctly | 1 | ||||
Answers both incorrectly | 2 | ||||
LOC commands‡ | Obeys both correctly | 0 | |||
Obeys one correctly | 1 | ||||
Obeys neither correctly | 2 | ||||
Gaze | Normal | 0 | |||
Partial gaze palsy; abnormal gaze in one or both eyes but no forced (involuntary) deviation and no total gaze paresis | 1 | ||||
Forced deviation or total gaze palsy (that is not corrected by the oculocephalic maneuver) | 2 | ||||
Visual field | No visual loss | 0 | |||
Partial hemianopia | 1 | ||||
Complete hemianopia | 2 | ||||
Bilateral hemianopia | 3 | ||||
Facial palsy | None | 0 | |||
Minor facial weakness | 1 | ||||
Partial facial weakness | 2 | ||||
Complete unilateral or bilateral paralysis | 3 | ||||
Motor arm function (score for both left and right sides) | No drift | 0 | |||
Drift before 10 seconds but does not hit bed or other support | 1 | ||||
Some effort against gravity | 2 | ||||
No effort against gravity | 3 | ||||
No movement | 4 | ||||
Motor leg function (score for both left and right sides) | No drift | 0 | |||
Drift before 5 seconds but does not hit bed or other support | 1 | ||||
Falls and hits bed before 5 seconds but has some effort against gravity | 2 | ||||
No effort against gravity | 3 | ||||
No movement | 4 | ||||
Limb ataxia | No ataxia | 0 | |||
Ataxia in 1 limb | 1 | ||||
Ataxia in 2 limbs | 2 | ||||
Untestable | — | ||||
Sensory | Normal | 0 | |||
Mild sensory loss | 1 | ||||
Severe sensory loss | 2 | ||||
Best language function§ | No aphasia | 0 | |||
Mild to moderate aphasia | 1 | ||||
Severe aphasia | 2 | ||||
Mute, global aphasia | 3 | ||||
Articulation/dysarthria | Normal articulation | 0 | |||
Mild to moderate dysarthria | 1 | ||||
Severe dysarthria (unintelligible or worse) | 2 | ||||
Untestable | — | ||||
Extinction or inattention | Absent | 0 | |||
Visual, tactile, auditory, spatial, or personal inattention or extinction to bilateral simultaneous stimulation in one of the sensory modalities | 1 | ||||
Profound hemi-inattention or extinction to more than one modality | 2 | ||||
* Total score is the sum of the scores for individual items. Degree of severity is indicated by the total score as follows:
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† Patients are asked their age and the current month. | |||||
‡ Patients are asked to open and close the eyes and to make a fist. | |||||
§ For aphasia:
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