The National Institutes of Health Stroke Scale, aka the NIHSS, is no walk in the park. This test is used by medical professionals to evaluate the effects and severity of an acute ischemic stroke. Get ready to use your noodle and search for subtle signs of neurological deficit as we break down the nih stroke scale answers.
When assessing a patient's level of consciousness on the NIHSS test, a score of 0 is normal, 1 is arousal to minor stimulation, 2 is arousal to painful stimulation, and 3 is completely unresponsive, aka coma. If little Jimmy opens his eyes when you gently shake his shoulder, he gets a 1. If he sleeps through loud noises but wakes up when you pinch his arm, he gets a 2. If he's out cold no matter how hard you pinch, slap a 3 on that bad boy.
When testing orientation on the NIHSS, ask the patient their age and the current month. 0 points means they answered both questions correctly, 1 point means they answered one correctly, and 2 points means they got both wrong or were too comatose to respond. So if little Jimmy thinks he's 25 when he's really 40 but knows it's February, give him a 1. Unless it's not February, then he gets a 2 for living under a rock all these years.
When testing the ability to follow commands on the NIHSS, have the patient open and close their eyes and then grip and release their non-paretic hand. A score of 0 indicates they correctly performed both tasks. A score of 1 means they could only do one, and a score of 2 means they couldn't follow either command. So if little Jimmy stares blankly while you repeatedly ask him to squeeze your hand, it doesn't look good for Jimmy.
Testing limb ataxia on the NIHSS involves having the patient run their heel down the length of their non-paretic shin. A score of 0 indicates no ataxia, 1 is present in one limb, and 2 is present in two limbs. Little Jimmy might start listing to one side like a sloppy sailor when attempting this maneuver if he has ataxia on the stroke side.
When testing sensation, the patient's limbs are lightly pinpricked both proximally and distally. A score of 0 means normal in both limbs, 1 means mild loss in one limb, 2 means severe loss in one limb, and 3 is loss in both limbs. So if Jimmy can't feel his affected arm and leg too well when poked but sensation is intact elsewhere, that's a 2 for Jimmy.
To score speech, have the patient recite phrase like "you can't teach an old dog new tricks". A score of 0 means normal speech, 1 is mild slurring, 2 is moderate slurring with some words recognizable, and 3 is complete inability to produce speech. If Jimmy babbles a string of unrecognizable sounds or is unable speak at all when asked to recite the phrase, it's a 3 for our little buddy.
And there you have it - a lighthearted look into scoring the NIHSS! It's all fun and games until little Jimmy codes. Then things get decidedly less amusing for everyone involved.
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