NIH Stroke Scale (NIHSS)

The NIH Stroke Scale describes the neurological deficit in acute stroke. It comprises 11 items with 15 sub-items; the total ranges from 0 to 42 points. Score what the patient actually does, not what you think they can do.

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1a – Level of consciousness

alert, keenly responsive 0not alert, but arousable by minor stimulation 1not alert, requires repeated stimulation or strong/painful stimulation to make movements 2responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid and areflexic 3

1b – LOC questions (month, age)

answers both correctly 0answers one correctly 1answers neither correctly 2

1c – LOC commands (open/close eyes, grip/release hand)

performs both tasks correctly 0performs one task correctly 1performs neither task correctly 2

2 – Best gaze (horizontal only)

normal 0partial gaze palsy 1forced deviation or total gaze paresis 2

3 – Visual fields

no visual loss 0partial hemianopia 1complete hemianopia 2bilateral hemianopia (blind, including cortical blindness) 3

4 – Facial palsy

normal symmetrical movements 0minor paralysis (flattened nasolabial fold, asymmetry on smiling) 1partial paralysis (total or near-total paralysis of the lower face) 2complete paralysis of one or both sides (absent movement in the upper and lower face) 3

5a – Motor arm, left

no drift (held at 90° or 45° supine for 10 s) 0drift before 10 s, does not hit the bed 1some effort against gravity 2no effort against gravity, limb falls 3no movement 4UN – untestable (amputation or joint fusion), not scored 0

5b – Motor arm, right

6a – Motor leg, left

no drift (held at 30° for 5 s) 0drift before 5 s, does not hit the bed 1some effort against gravity 2no effort against gravity, leg falls immediately 3no movement 4UN – untestable (amputation or joint fusion), not scored 0

6b – Motor leg, right

7 – Limb ataxia

absent 0present in one limb 1present in two limbs 2UN – untestable (amputation or joint fusion), not scored 0

8 – Sensory

normal, no sensory loss 0mild-to-moderate sensory loss 1severe to total sensory loss 2

9 – Best language

no aphasia, normal 0mild-to-moderate aphasia 1severe aphasia 2mute, global aphasia 3

10 – Dysarthria

normal 0mild-to-moderate dysarthria 1severe dysarthria (unintelligible) or mute/anarthric 2UN – untestable (intubated or other physical barrier), not scored 0

11 – Extinction and inattention (neglect)

no abnormality 0visual, tactile, auditory, spatial or personal inattention or extinction in one sensory modality 1profound hemi-inattention or extinction to more than one modality 2

–points

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Classification (original publication)

Score	Classification (original publication)
0–42	NIHSS total – higher values indicate a more severe neurological deficit; the original publication defines no severity categories; items marked UN are not included in the total

Structure

In 1989, Brott et al. introduced a 15-item examination scale for acute stroke therapy trials. The version in use today (NINDS form) has 11 items with 15 sub-items: consciousness (1a–1c), gaze, visual fields, facial palsy, motor function of each arm and leg separately, ataxia, sensation, language, dysarthria and extinction/inattention. The maximum is 42 points.

“UN” (untestable) is recorded for items that cannot be tested because of amputation, joint fusion or intubation; they are not added to the total. Ataxia is scored only if it is out of proportion to weakness. Lyden et al. (1994) showed that video training improves agreement between examiners.

Limitations

The NIHSS contains no items for vertigo, gait disturbance or dysphagia; a low score therefore does not rule out stroke. Certified training is available for reliable use.

Copyright

The NIH Stroke Scale was developed with public funding by the US National Institute of Neurological Disorders and Stroke (NINDS) and is free to use. The short descriptions of the scores on this page follow the official NINDS form.

FAQ

What is the maximum NIHSS?▾

42 points. The individual items score between 0–2 and 0–4 points; the four motor sub-items for arms and legs score 0–4 each.

What does UN mean in the NIHSS?▾

UN stands for untestable: the item cannot be tested because of amputation, joint fusion or intubation and is not counted.

References

Brott T et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–70. · PubMed
Lyden P et al. Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke 1994;25:2220–6. · PubMed
National Institute of Neurological Disorders and Stroke (NINDS). NIH Stroke Scale – offizielles Formular (frei verwendbar). · ninds.nih.gov

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Intended purpose: learning tool for medical education only. Not intended for use in patients or for diagnostic or treatment decisions; not a medical device. Calculations follow the cited original publications; no guarantee of completeness or correctness. Last updated: 10/2026 · Dr. Pascal Bafteh