About

The National Institutes of Health Stroke Scale (NIHSS) is the world's most widely used defect scoring system for quantifying stroke impairment. It allows healthcare providers to track the patient's neurological status over time, facilitating communication between emergency responders, nurses, and neurologists. A baseline score is essential for determining eligibility for tPA (tissue plasminogen activator) treatment.

This application simplifies the complex 11-item checklist into an interactive bedside tool. It automatically sums the points (Range: 0-42) and categorizes the stroke severity from "Minor" to "Severe". It is designed for speed and accuracy in high-pressure clinical environments.

Formulas

The final score is a simple arithmetic sum of the 15 sub-items (derived from the 11 main categories). No complex weighting is applied; however, specific rules apply for patients who are intubated, blind, or have amputated limbs.

Score = 15∑i=1 Item_i

Items include Level of Consciousness (LOC), Gaze, Visual, Facial Palsy, Motor function (Arms/Legs), Ataxia, Sensory, Language, Dysarthria, and Extinction.

Reference Data

Score Range	Stroke Severity	Clinical Implication
0	No Stroke Symptoms	Normal neurological function.
1 - 4	Minor Stroke	Often discharged home; favorable prognosis.
5 - 15	Moderate Stroke	Requires inpatient care; rehabilitation likely needed.
16 - 20	Moderate to Severe	Significant impairment; intensive therapy required.
21 - 42	Severe Stroke	High mortality risk; extensive long-term care.

Frequently Asked Questions

For Item 10 (Dysarthria), assign a score of "Untestable" (UN) or 9, though typically in calculation tools, the clinician must interpret the best fit or note the limitation. This tool treats the selection strictly numerically.

The NIHSS is heavily weighted towards anterior circulation deficits (hemispheric strokes). It may underestimate the severity of posterior circulation strokes (brainstem/cerebellum) which present with dizziness or ataxia rather than weakness.

Standard protocol is at baseline (admission), 2 hours post-treatment, 24 hours post-onset, 7 days, and at discharge. Fluctuations of 4 or more points indicate significant clinical change.