The National Institutes of Health Stroke Scale (NIHSS) is the standard measure of neurological deficit after stroke. Fifteen items cover consciousness, gaze, vision, facial movement, limb strength and coordination, sensation, language, speech and neglect, and add up to a total from 0 to 42.
It is used in emergency departments to quantify severity and support treatment decisions, and repeated through the admission to track change. Score the items in order, and record what the patient does on the first attempt.
Zdrovia: https://www.zdrovia.ca/resources/nih-stroke-scale/
Stroke Severity
NIH Stroke Scale (NIHSS) Calculator
Score the 15 NIHSS items in order for the total out of 42 and the severity band. Score what the patient does on the first attempt, not what you think they could do.
Arm held at 90° (sitting) or 45° (supine) for 10 seconds.
Leg held at 30° (supine) for 5 seconds.
Finger-nose and heel-shin; score only if out of proportion to weakness.
Total score
0 of 15 items scored
Score every item to see the result
Item breakdown
These results are estimates based on published clinical data and are for informational purposes only. They do not constitute medical advice, a diagnosis, or a treatment recommendation. Consult a licensed aesthetic practitioner before beginning any treatment. Individual results vary.
Zdrovia's smart blocks drop validated scales into the visit note, keep every item score, and graph the total across visits so the trend is visible at a glance. See how smart blocks work →
NIHSS scoring table
| Item | What is tested | Score range |
|---|---|---|
| 1a | Level of consciousness | 0–3 |
| 1b | LOC questions: month and age | 0–2 |
| 1c | LOC commands: eyes and grip | 0–2 |
| 2 | Best gaze | 0–2 |
| 3 | Visual fields | 0–3 |
| 4 | Facial palsy | 0–3 |
| 5a / 5b | Motor arm, left and right | 0–4 each |
| 6a / 6b | Motor leg, left and right | 0–4 each |
| 7 | Limb ataxia | 0–2 |
| 8 | Sensory | 0–2 |
| 9 | Best language | 0–3 |
| 10 | Dysarthria | 0–2 |
| 11 | Extinction and inattention | 0–2 |
Total 0–42. A limb that can't be tested (amputation, joint fusion) is recorded as UN and explained, and not added to the total.
NIHSS score interpretation
| Total | Stroke severity |
|---|---|
| 0 | No stroke symptoms |
| 1–4 | Minor stroke |
| 5–15 | Moderate stroke |
| 16–20 | Moderate to severe stroke |
| 21–42 | Severe stroke |
Score it straight into the chart
Zdrovia's smart blocks drop validated scales into the visit note, keep every item score, and graph the total across visits so the trend is visible at a glance.
How to score the NIHSS correctly
Administer the items in the listed order and don't go back to change a score. Record what the patient actually does, not what you think they could do, and don't coach. For motor items, test each limb separately and count aloud: 10 seconds for arms, 5 seconds for legs.
The items that cause most inconsistency between raters are ataxia (score it only when it is out of proportion to weakness), sensory loss in a drowsy patient, and language in a patient who is intubated. Certification training through the American Heart Association or the NIH is the standard way to calibrate.
What the score does and doesn't tell you
Higher scores mean larger deficits and generally worse outcomes, and changes over the first days help show whether a patient is improving or deteriorating. But the scale weights left-hemisphere and anterior circulation deficits more heavily: a disabling posterior circulation stroke or isolated aphasia can score low. A low score is never a reason on its own to withhold treatment.
Prehospital screen: Cincinnati Prehospital Stroke Scale →
Measuring recovery: Modified Barthel Index calculator →
References
Other clinical assessment references