NIH Stroke Scale Assesses Neurologic Deficits in Stroke Patients

Learn about the NIH Stroke Scale, a tool to quantify neurological impairment after stroke. Covers scoring and assessment of consciousness, gaze, visual fields, motor function, speech, and attention. Beneficial for medical providers evaluating and treating stroke patients.

Overview of the NIH Stroke Scale

The National Institutes of Health Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that area, while a higher score is indicative of some level of impairment. The individual scores from each item are summed to calculate a patient's total NIHSS score. A higher total score is associated with more severe neurological deficit.^[1]

Level of Consciousness: Questions 1a - 1c

The NIHSS includes three questions related to the patient's level of consciousness (LOC). Question 1a asks if the patient is alert, defined as being awake, aware, and attentive. An alert patient scores 0. Question 1b assesses the patient's degree of orientation to person, place, and time. A fully oriented patient scores 0. Question 1c tests the patient's ability to follow commands by having them perform simple tasks like closing their eyes or making a fist. A patient who performs both tasks correctly receives a score of 0.^[2]

Best Gaze, Visual Fields, Facial Palsy: Questions 2-4

Questions 2-4 involve the patient's eye movements and visual fields. For question 2, the patient follows the examiner's finger or face as it moves side to side to test for abnormal gaze. Question 3 tests each visual field by having the patient count fingers in their peripheral vision. Question 4 evaluates facial palsy by assessing the symmetry of the patient's facial expressions, like showing teeth or raising eyebrows. Scoring is based on presence and severity of deficits.^[3]

Motor Function, Ataxia: Questions 5-8

The next section examines the patient's motor function on both sides of the body. Question 5 tests arm and hand motor function by assessing resistance against gravity and ability to hold posture. Question 6 evaluates leg motor function by having the patient hold their leg elevated. Question 7 assesses coordination by testing for limb ataxia. Question 8 checks for sensory loss by examining response to being touched or pricked on the limbs and face.^[4]

Language, Articulation: Questions 9-10

Questions 9 and 10 involve speech and language abilities. Question 9 evaluates the patient's ability to produce language by naming items, having a conversation, reading and comprehending. Question 10 specifically tests articulation by having the patient repeat words starting with "hippopotamus". Scoring depends on presence of aphasia and ability to articulate words clearly.^[5]

Extinction or Inattention: Question 11

The final NIHSS item tests for visual inattention or extinction. The patient is asked to close their eyes and identify which side is being stimulated when the examiner touches both arms simultaneously. Missing one side consistently indicates unilateral inattention to that side.^[6]

In summary, the NIHSS provides a quantitative assessment of key neurological domains through a simple, standardized exam that is fast and easy to administer. Scores help determine severity of stroke and qualify patients for certain acute treatments.

[1] National Institute of Neurological Disorders and Stroke. NIH Stroke Scale. https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf [2] Ibid [3] Ibid [4] Ibid [5] Ibid [6] Ibid

Several facts about nih stroke scale answers group b

Stroke Assessment

The NIH Stroke Scale is a standardized tool used to evaluate and quantify impairment caused by an acute stroke. It allows healthcare providers to measure neurological deficits in key functions like motor ability, speech, and consciousness. Scores help determine severity of stroke and guide treatment decisions.

Neurological Exam

The NIH Stroke Scale serves as a focused neurological exam to evaluate specific domains like language, coordination, sensory function, and visual fields. It provides objective quantification of impairment through a simple, rapid bedside assessment.

Stroke Symptoms

Symptoms assessed by the NIH Stroke Scale include weakness, trouble speaking or understanding language, vision issues, and lack of coordination or balance. Testing these deficits helps determine extent of neurological injury.

Acute Ischemic Stroke

The NIH Stroke Scale is commonly used to evaluate impairment in acute ischemic stroke, which results from a blocked blood vessel in the brain. It helps guide use of thrombolytic medicines to dissolve clots.

Hemorrhagic Stroke

Hemorrhagic strokes caused by bleeding in the brain can also be evaluated with the NIH Stroke Scale. It aids in determining severity and appropriate treatment approaches.

Stroke Classification

NIH Stroke Scale scores help classify severity of stroke as mild, moderate or severe. This guides prognosis and intensity of care required during recovery.

Stroke Recovery

The scale provides a baseline deficit assessment to track recovery during rehabilitation. Improvement in scores demonstrates progress and restoration of neurological function.

Stroke Prognosis

Higher NIHSS scores indicate more severe strokes, which are associated with increased disability and mortality. The scale aids in determining prognosis.

Stroke Treatment

The NIH Stroke Scale guides acute treatment decisions regarding thrombolytic drugs to dissolve clots in ischemic stroke. It also helps determine need for surgical intervention.

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