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Neurology

The National Institutes of Health Stroke Scale (NIHSS) Score Calculator

NIHSS (scale) calculator

The National Institutes of Health Stroke Scale (NIHSS) is a widely used standardized tool for measuring the severity of a stroke. It is used to assess the level of neurological impairment caused by a stroke and to track the patient's progress over time.

The NIHSS is a series of tests and questions that evaluate the patient's level of consciousness, vision, speech, movement, sensation and coordination. The results are used to determine the appropriate treatment, predict the patient's outcome and evaluate the effectiveness of different stroke treatments.

It's also used to measure the improvement or deterioration of symptoms between hospital admission and discharge. The NIHSS score ranges from 0 to 42 and is calculated by answering a questionnaire made up of 15 total queries, with higher scores indicating more severe strokes.

Last update: 24 Jan 2023 22:09

The NIHSS score is a strong indicator of a patient's chances of recovering from a stroke. A high score (≥16) indicates a high likelihood of death or severe disability, while a low score (≤6) suggests a good chance of recovery.

However, the TOAST subtype of lacunar stroke is the only exception, as it can predict outcomes regardless of the NIHSS score. The severity of stroke can also be classified accordingly:

Score of 1-4: Minor Stroke
Score of 5-15: Moderate Stroke damage
Score of 15-20: Severe Stroke
More than 20: Extremely severe impairment

Attention

0 on the NIHSS scale does not indicate the absence of a cerebral ischemic/hemorrhaging event. The patient may present with localized neurological signs that may not be able to be detected when searching for the NIHSS criteria. According to the studies cited, the most frequently associated symptoms in this category of patients were:

headache
vertigo
nausea

Truncal ataxia was the most common neurologic sign presented.
If in doubt, please seek immediate expertise from a neurologist.

Attention

Attention: It is equally important to pay attention to the fact that patients with a modified NIHSS score may not always present cerebral ischaemia. Multiple other neurological diseases and even medullary diseases may present with a modified NIHSS score. Please check symmetry of neurological signs to make an appropriate early differential diagnosis.

References

1. Baseline NIH Stroke Scale score strongly predicts outcome after stroke. Harold P. Adams, P. H. Davis et al.. Neurology, 53, 1, 7 1999

2. Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes. S. Sato, K. Toyoda et al.. Neurology, 70, 24 Part 2, 6 2008

3. Zero on the NIHSS Does Not Equal the Absence of Stroke. Sheryl Martin-Schild, Karen C. Albright et al.. Annals of Emergency Medicine, 57, 1, 1 2011

4. NIHSS Score and Arteriographic Findings in Acute Ischemic Stroke. Urs Fischer, Marcel Arnold et al.. Stroke, 36, 10, 10 2005

5. Predictors of Outcome in Patients with Medullary Hemorrhage. Emre Kumral, Fatma Ece Bayam et al.. Journal of Stroke and Cerebrovascular Diseases, 29, 12, 12 2020

6. Outcome of patients with large vessel occlusion in the anterior circulation and low NIHSS score. Mirjam R. Heldner, Panagiotis Chaloulos-Iakovidis et al.. Journal of Neurology, 267, 6, 6 2020

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Lesson authors: Dr. Mironescu Olivier, Dr. Huțuleac Oana Mihaela

Published on: 24 Jan 2023 22:09

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The National Institutes of Health Stroke Scale (NIHSS) is a widely used standardized tool for measuring the severity of a stroke. It is used to assess the level of neurological impairment caused by a stroke and to track the patient's progress over time.

The NIHSS is a series of tests and questions that evaluate the patient's level of consciousness, vision, speech, movement, sensation and coordination. The results are used to determine the appropriate treatment, predict the patient's outcome and evaluate the effectiveness of different stroke treatments.

It's also used to measure the improvement or deterioration of symptoms between hospital admission and discharge. The NIHSS score ranges from 0 to 42 and is calculated by answering a questionnaire made up of 15 total queries, with higher scores indicating more severe strokes.

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