TRAUMA YELLOW
  • Clinical
    • Discharge Macros
    • Suboxone
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map

NIH Stroke Scale & Training

12/8/2016

4 Comments

 
The NIH stroke scale it used to identify the severity of stroke like symptoms, and should be scored on the patient's initial presentation, without coaching or duplication. It is important to be consistent when scoring all patients, and identify all deficits. 

NIH stroke scale scores patients 0-42, with higher scores indicating increased severity.

Training for appropriate use of the NIH stroke scale is free, at http://nihss-english.trainingcampus.net/

iPhone applications, such as StatCoder, are available and free.
Picture

Level of Consciousness

  • First, identify if the patient is alert, arousable to verbal stimuli, arousable to repeated stimuli or painful stimuli, or if the patient is unresponsive.
  • Second, ask two questions are asked to identify LOC; the patient's age, and the current month. If they respond with their date of birth, this is incorrect. 
  • Third, ask the patient to open and close their eyes, then grip and release the non-affected hand. Remeber to not coach the patient, however you can repeat the command twice, and pantomine gripping while asking. 

Best Gaze

  • Test horizontal gaze only. Note the eye position at rest, and then have the patient follow a horizontal target. If the patient has partially abnormal gaze, or abnormal gaze in a single eye, they score 1. If they are unable to overcome paresis, this is a 2. You can also identify eye movement palsy by watching the patient track people or items in the room. 

Visual Testing

  • Upper and lower quadrants should be tested by confrontation (finger movements or counting) in each eye. Ensure the patient is looking ahead when testing peripheral vision. If the patient has poor LOC, bilateral confrontational/threat can be used to test. If any loss of vision corrects with bilateral testing, then the score is 1. If hemianopia is present in monocular and binocular testing, this is a 2. If there is complete bilateral blindness, this is scored as a 3. 

Facial Palsy

  • Score symmetry of grimace in poorly responsive patients, or your normal motor exam of the facial nerve. Complete paralysis of one or both sides is a 3, partial paralysis is a 2, and minor flattening of the nasolabial fold, or an asymetric smile, is a 1.  

Motor Arms

  • Test motor drift over 10 seconds in the appropriate position. You can place arms in the appropriate position prior to starting, and any immediate 'dip' of the arm is not to be scored. Only score gradual drift over the time period. Each limb should be tested separately. Score each arm 0-4, no drift, minimal drift, effort against gravity but drifts completely down to bed, or no movement

Motor Legs

  • Test motor drift over 10 seconds in the appropriate position. You can place legs in the appropriate position prior to starting, and any immediate 'dip' of the leg is not to be scored. Only score gradual drift over the time period. Each limb should be tested separately. Score each leg 0-4, no drift, minimal drift, effort against gravity but drifts completely down to bed, or no movement

Limb Ataxia

  • Identify any unilateral cerebellar lesion by testing finger-nose and heel-shin tests, while using the visual fields that are not affected. 

Sensory Testing

  • Test for sensory loss to pinprick or noxious stimuli. 

Best Language

  • Have the patient describe what is happening in a photo, and ask the patient to name items on a naming sheet. Comprehension and ability to express ideas are both being tested. 

Dysarthria

  • Separate from language and comprehension, aphasia should be tested separately, and scorred 1 for mild slurring, and 2 for severe slurring that inhibits communication. 

Extinction & Inattention

  • Extinction of sensation or other stimuliation during bilateral stimuliation i.e. sensation, auditory testing, spatial awareness, or personal inattention. If the patient has profound inattention, i.e. cannot identify his/her own hand, this is scored as a 2. 
4 Comments
Victoria Addington link
11/28/2022 07:37:37 am

I liked it the most when you shared that we should identify first if the patient is unresponsive. My friend wants to know more about the NIHSS stroke scale. I think he should take a program that provides the tools and education to become certified with the NIHSS stroke scale.

Reply
Athony Isak
6/5/2025 08:01:04 am

My heart is so filled with joy. If you are suffering from Erectile dysfunction or any other disease you can contact Dr. Moses Buba on this [email protected] or His website : https://www.facebook.com/profile.php?id=61559577240930 .website page https://bubaherbalmiraclem.wixsite.com/website
. For more information from me reach me via WhatsApp : +44 7375 301397

Reply
Korean Escort Ballarat link
6/5/2025 08:02:31 pm

This blog post provides a clear and concise explanation of how to use the NIH stroke scale.

Reply
Hailey Garcia
6/9/2025 07:25:01 am

EFFECTIVE WAY TO GET YOUR HERPES CURE/MEDICINE ORDER FROM DR. ODUNGA HERBAL REMEDIES

My name is Hailey Garcia and I am from New Jersey. My herpes virus turned to war after 2 years of living with it. I have tried different procedures to cure my herpes but to no avail. Most people think herpes is only a minor skin irritation of which herpes has long term effects on health and passes through the bloodstream and can be easily contracted through sexual intercourse. I knew I had herpes from the first day I started feeling itchy in my pubic area and the pain was very unbearable. I couldn't stand it anymore. After 2 years of trying other means to get rid of it, I had to contact Doctor Odunga to help me with a permanent cure. I saw his email and whats-app number from a testimony I read online from a lady who was also helped by him in curing infertility problems, I had faith and contacted him. He assured me of his work and I ordered his herbal medicine. Within 5 days, I didn't feel any pain anymore and within 2 weeks, my skin was all cleared and smooth. I am very grateful to you sir and I write this testimony as others have done to bring those having faith to you sir. If you have herpes or other similar disease and you want it cured, kindly contact Doctor Odunga, Whats-App (wa.me/+2348167159012) OR Email [email protected]

Reply



Leave a Reply.

    Categories

     

    All
    Abx
    Article
    Cardiac
    EKG
    EKG Challenge
    GI Bleed
    Grand Rounds
    Headache
    ICU
    Orthopedic
    Pain
    Peds
    Reading
    Stroke
    Subarachnoid Hemorrhage
    Syncope
    Teaching Pearl
    Trauma
    Travel
    Zika

    Archive

     

    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    January 2016
    December 2015
    November 2015

    Picture
    Please read our Terms of Use.
Donate
This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

​Please refer to our Terms of Use. 
  • Clinical
    • Discharge Macros
    • Suboxone
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map