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How is the NIH Stroke Scale (NIHSS) Used for The Evaluation of Stroke?


Updated October 11, 2013

How is the NIH Stroke Scale (NIHSS) Used for The Evaluation of Stroke?


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Question: How is the NIH Stroke Scale (NIHSS) Used for The Evaluation of Stroke?


The National Institutes of Health (NIH) Stroke Scale (NIHSS) is a standardized tool used by physicians and other health care professionals to measure the level of impairment caused by a stroke.

The NIH Stroke Scale serves several purposes, but its main use in clinical medicine is during the assessment of whether or not the degree of disability caused by a given stroke merits treatment with tPA. Another important use of the NIHSS is in research, where it allows for the objective comparison of efficacy across different stroke treatments and rehabilitation interventions.

The NIH Stroke Scale measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language. A certain number of points are given for each impairment uncovered during a focused neurological examination. A maximal score of 42 represents the most severe and devastating stroke. Guidelines as of 2008 allow strokes with scores greater than 4 points to be treated with tPA.

The level of stroke severity as measured by the NIH stroke scale scoring system:

  • 0= no stroke
  • 1-4= minor stroke
  • 5-15= moderate stroke
  • 15-20= moderate/severe stroke
  • 21-42= severe stroke

Bradley G Walter, Daroff B Robert, Fenichel M Gerald, Jancovic, Joseph; Neurology in clinical practice, principles of diagnosis and management. Philadelphia Elsevier, 2004.


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