Table of ContentsView AllTable of ContentsStrokeNIHSS MeasurementUsesPrognosis
Table of ContentsView All
View All
Table of Contents
Stroke
NIHSS Measurement
Uses
Prognosis
The NIH Stroke Scale (NIHSS) is a standardized scoring assessment used during a neurological exam after someone has had a stroke. It measures aspects of brain function, including consciousness, vision, sensation, movement, speech, and language.
This article discusses the components of the NIHSS, when it is given, and how it is used.
Getty Images / David Sacks
What Is a Stroke?
Astrokeis a serious health condition that occurs when the blood supply to a part of the brain is blocked or when a blood vessel in the brain bursts. When blood flow to the brain is blocked or restricted, parts of the brain become damaged or die.
Stroke effects depend on which area of the brain is affected and can include physical weakness, loss of balance, decreased sensation, trouble speaking, and a number of other problems.
Stroke is the fifth most common cause of death and a leading cause of disability in the United States.
What Does the NIHSS Measure?
The NIHSS measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language.
NIHSS score is usually first determined in the emergency department, as soon as possible after the onset of stroke symptoms. It will also be applied at regular intervals, and/or whenever the person’s condition changes significantly (either improving or declining).
The NIHSS contains 15 questions covering 11 elements that measure specific functions. The elements include:
Each element is evaluated with a numerical score. The higher the number, the greater impairment for that specific function. A maximum score of 42 represents the most severe and devastating stroke.
How Is the NIH Stroke Scale Used?
The NIHSS is used for several different purposes, including guiding treatment decisions and providing a standard scale for researchers and clinicians to use.
To Guide Clinical Decisions
The NIHSS serves as the foundation for clinical decision-making when a patient arrives at the hospital presenting with a stroke. Joint guidelines from the American Heart Association and the American Stroke Association recommend the use of NIHSS to quantify the degree of neurological deficit, facilitate communication, and identify patients suitable for treatment withtPA(tissueplasminogenactivator).
This medication is a powerful blood thinner that can improve stroke outcomes, but it can only be used in limited situations. NIHSS also provides a basis for healthcare providers to determine changing clinical status, including keeping watch for patients at higher risk for complications such as brain hemorrhage.
As a Research Tool
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. This can help researchers determine, with uniform criteria, whether a medical treatment is effective in the treatment of stroke.
To Help Healthcare Providers Communicate
In general, neurologists and other healthcare providers who take care of you during and after your stroke use detailed clinical records to communicate about your condition. The NIHSS stroke scale is a number that can convey the severity of your stroke but is not the main point that your healthcare providers look at when assessing your condition and making treatment decisions.
However, the uniformity of the scale can help your healthcare providers get a picture of how much your stroke has improved or worsened over time.
How the Score Predicts Prognosis
A person’s prognosis related to NIHSS scores at admission to the emergency room are as follows:
The validity of the NIHSS is reduced if:
Summary
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.About stroke.Lui SK, Nguyen MH.Elderly stroke rehabilitation: Overcoming the complications and its associated challenges.Curr Gerontol Geriatr Res. 2018;2018:9853837. doi:10.1155/2018/9853837American Heart Association.Stroke falls to No. 5 killer in U.S.National Institute of Neurological Disorders and Stroke.NIH stroke scale.Harrison JK, Mcarthur KS, Quinn TJ.Assessment scales in stroke: Clinimetric and clinical considerations.Clin Interv Aging. 2013;8:201-11. doi:10.2147/CIA.S32405Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council.2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158.Physiopedia.NIH stroke scale.Additional ReadingSiegler JE, Martin-Schild S,Daily National Institutes of Health Stroke Scale examinations at stroke centers: Why not do them?Int J Stroke.2015 Feb;10(2):140-2. doi: 10.1111/ijs.12416
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.About stroke.Lui SK, Nguyen MH.Elderly stroke rehabilitation: Overcoming the complications and its associated challenges.Curr Gerontol Geriatr Res. 2018;2018:9853837. doi:10.1155/2018/9853837American Heart Association.Stroke falls to No. 5 killer in U.S.National Institute of Neurological Disorders and Stroke.NIH stroke scale.Harrison JK, Mcarthur KS, Quinn TJ.Assessment scales in stroke: Clinimetric and clinical considerations.Clin Interv Aging. 2013;8:201-11. doi:10.2147/CIA.S32405Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council.2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158.Physiopedia.NIH stroke scale.Additional ReadingSiegler JE, Martin-Schild S,Daily National Institutes of Health Stroke Scale examinations at stroke centers: Why not do them?Int J Stroke.2015 Feb;10(2):140-2. doi: 10.1111/ijs.12416
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.About stroke.Lui SK, Nguyen MH.Elderly stroke rehabilitation: Overcoming the complications and its associated challenges.Curr Gerontol Geriatr Res. 2018;2018:9853837. doi:10.1155/2018/9853837American Heart Association.Stroke falls to No. 5 killer in U.S.National Institute of Neurological Disorders and Stroke.NIH stroke scale.Harrison JK, Mcarthur KS, Quinn TJ.Assessment scales in stroke: Clinimetric and clinical considerations.Clin Interv Aging. 2013;8:201-11. doi:10.2147/CIA.S32405Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council.2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158.Physiopedia.NIH stroke scale.
Centers for Disease Control and Prevention.About stroke.
Lui SK, Nguyen MH.Elderly stroke rehabilitation: Overcoming the complications and its associated challenges.Curr Gerontol Geriatr Res. 2018;2018:9853837. doi:10.1155/2018/9853837
American Heart Association.Stroke falls to No. 5 killer in U.S.
National Institute of Neurological Disorders and Stroke.NIH stroke scale.
Harrison JK, Mcarthur KS, Quinn TJ.Assessment scales in stroke: Clinimetric and clinical considerations.Clin Interv Aging. 2013;8:201-11. doi:10.2147/CIA.S32405
Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council.2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158.
Physiopedia.NIH stroke scale.
Siegler JE, Martin-Schild S,Daily National Institutes of Health Stroke Scale examinations at stroke centers: Why not do them?Int J Stroke.2015 Feb;10(2):140-2. doi: 10.1111/ijs.12416
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