NIH Stroke Scale Questions and Answers 2023

NIH Stroke Scale Questions and Answers 2023 Score for large strokes 10 (however, if it is a brainstem stroke it can have a low score and still be a large stroke) Lowest score Highest score Lowest score is 0 Highest score is 42 Components of Eyes Gaze - voluntary gaze direction (non-comatose) - vestibule-ocular reflex (comatose) Visual fields - confrontation, all 4 quadrants (non-comatose) - threat (comatose) Components of LOC Arousal Questions - name - month Commands - open eyes - grip/release Components of Face Facial droop - smile & eyebrow raise (normal LOC / drowsy) - grimace w/ pain (obtunded) Components of Motor Strength Arm strength - raise arms 45° (supine) - raise arms 90° (sitting) Leg strength - raise legs 30° (always test supine) Components of Limb Ataxia Finger→nose & Heel→shin Components of Sensory Pinprick - all 4 limbs; up to elbow Components of Language Aphasia - describe picture; name objects (w/ adequate vision) - describe large objects in room or ask questions (w/ inadequate vision) Components of Dysarthria Character of speech - read sentences / words (w/ adequate vision) - repeat "methodist episcopal" (w/ inadequate vision) - listen for slurred, garbled, incoherent Components of Extinction/Inattention Vision extinction: - look at wiggling hand Sensory test - upper & lower extensors Special Cases Unconscious patients will have a high score; does NOT mean they had a stroke NIH stroke scale is heavily weighted for aphasic left hemisphere MCA stroke. Brainstem stroke could have a low score and have a serious stroke. Isolated gaze palsy (+1) If the patient has unilateral blindness or enucleation, use the remaining eye's visual fields Amputation or joint fusion get score of "UN" for strength & limb ataxia becaues they can not perform (make sure to document why) Aphasic Pt can be encouraged during strength exam w/ pantomime or urgency, but NOT noxious stimulation Ataxia only scored if positive; comatose or paralyzed get a 0 Intubated Pt should write to complete language (aphasia) portion when possible and get "UN" for dysarthria (motor speech) portion LOC: Arousal - drowsy 1 LOC: Arousal - Alert 0 LOC: Arousal - aroused w/ minor stimulus 1 LOC: Arousal - obtunded 2 LOC: Arousal - aroused w/ repeated stimulation 2 LOC: Arousal - unresponsive 3 LOC: Arousal - only reflexive response 3 LOC: Name & Month - answers both correct 0 LOC: Name & Month - answers 1 correct 1 LOC: Answer name & month - answers neither correct 2 LOC: Eye opening; Grip/release - performs both 0 LOC: Eye opening; Grip/release - performs neither 2 LOC: Eye opening; Grip/release - performs 1 1 Eyes: Voluntary gaze - normal 0 Eyes: Voluntary gaze - gaze deviation, but can be overcome 1 Eyes: Voluntary gaze - gaze deviation, can not be overcome (palsy) 2 Eyes: Visual fields - normal 0 Eyes: Visual fields - partial hemianopia 1 Eyes: Visual fields - complete hemianopia 2 Eyes: Visual fields - total blindness bilaterally (cortical blindness) 3 Face: Facial droop - can smile & raise eyebrows 0 Face: Facial droop - mild facial asymmetry (flattened nasolabial fold) 1 Face: Facial droop - lower facial droop, but can raise eyebrows 2 Face: Facial droop - complete paralysis of one or both sides of the face 3 Motor Strength: Arm - no drift before 10 seconds 0 Motor Strength: Arm - arm drifts, but does not hit bed before 10 seconds 1 Motor Strength: Arm - arm drifts down to bed before 10 seconds 2 Motor Strength: Arm - no effort against gravity 3 Motor Strength: Arm - no movement at all 4