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NIHSS Stroke Scale (Detailed)

Score all 11 NIHSS items and get an instant severity interpretation for acute stroke assessment.

Use the NIHSS Stroke Scale (Detailed)

Educational use only. This tool is not a substitute for certified clinical NIHSS assessment. Always defer to trained clinicians for patient care decisions.

1a: Level of Consciousness

Item 1a

Level of Consciousness

0 — Alert; keenly responsive 1 — Not alert; arousable by minor stimulation 2 — Not alert; requires repeated stimulation to attend 3 — Responds only with reflex motor or autonomic effects, or totally unresponsive

1b: LOC Questions

Item 1b

LOC Questions

Ask month and patient's age

0 — Answers both correctly 1 — Answers one correctly 2 — Answers neither correctly

1c: LOC Commands

Item 1c

LOC Commands

Open/close eyes; grip and release non-paretic hand

0 — Performs both tasks correctly 1 — Performs one task correctly 2 — Performs neither task correctly

2: Best Gaze

Item 2

Best Gaze

Horizontal eye movements only

0 — Normal 1 — Partial gaze palsy 2 — Forced deviation, or total gaze paresis

3: Visual Fields

Item 3

Visual Fields

Confrontation testing of all four visual field quadrants

0 — No visual loss 1 — Partial hemianopia 2 — Complete hemianopia 3 — Bilateral hemianopia (blind including cortical blindness)

4: Facial Palsy

Item 4

Facial Palsy

Ask patient to show teeth, raise eyebrows, close eyes

0 — Normal symmetrical movement 1 — Minor paralysis (flattened nasolabial fold, asymmetry on smiling) 2 — Partial paralysis (total or near-total lower face paralysis) 3 — Complete paralysis (upper and lower face)

5 Left: Motor Arm (Left)

Item 5 — Left

Motor Arm — Left

Extend arm 90° (sitting) or 45° (supine), hold 10 seconds

0 — No drift; holds for full 10 seconds 1 — Drift; holds some position but drifts before 10 seconds 2 — Some effort against gravity; arm cannot reach or maintain position 3 — No effort against gravity; limb falls immediately 4 — No movement

5 Right: Motor Arm (Right)

Item 5 — Right

Motor Arm — Right

Extend arm 90° (sitting) or 45° (supine), hold 10 seconds

6 Left: Motor Leg (Left)

Item 6 — Left

Motor Leg — Left

Leg held at 30°, hold 5 seconds (always tested supine)

0 — No drift; holds for full 5 seconds 1 — Drift; leg falls by end of 5 seconds but does not hit bed 2 — Some effort against gravity; leg falls to bed by 5 seconds 3 — No effort against gravity; leg falls to bed immediately 4 — No movement

6 Right: Motor Leg (Right)

Item 6 — Right

Motor Leg — Right

Leg held at 30°, hold 5 seconds (always tested supine)

7: Limb Ataxia

Item 7

Limb Ataxia

Finger-nose and heel-shin tests bilaterally

0 — Absent 1 — Present in one limb 2 — Present in two limbs

8: Sensory

Item 8

Sensory

Pinprick; face, arm, trunk, and leg tested

0 — Normal; no sensory loss 1 — Mild-to-moderate sensory loss; patient feels pinprick less sharp on affected side 2 — Severe or complete sensory loss; patient is not aware of being touched

9: Best Language

Item 9

Best Language

Name items, describe picture, read sentences

0 — No aphasia; normal 1 — Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension 2 — Severe aphasia; fragmentary expression, inference needed, cannot identify materials 3 — Mute, global aphasia; no usable speech or auditory comprehension

10: Dysarthria

Item 10

Dysarthria

Read or repeat listed words

0 — Normal 1 — Mild-to-moderate; patient slurs at least some words 2 — Severe; patient's speech is unintelligible or mute/anarthric

11: Extinction and Inattention

Item 11

Extinction and Inattention

Bilateral simultaneous stimulation; visual/tactile/auditory neglect

0 — No abnormality 1 — Visual, tactile, auditory, spatial, or personal inattention 2 — Profound hemi-inattention or hemi-inattention to more than one modality

Total Score

Severity

No Stroke Symptoms

Score Summary

0 / 42

No Stroke Symptoms

Score of 0 indicates no detectable neurological deficit.

Item Breakdown

Summary

The National Institutes of Health Stroke Scale (NIHSS) is a standardized 11-item neurological examination used to quantify stroke severity. This tool walks through every item — from level of consciousness to extinction and inattention — and produces a total score with clinical severity classification.

How it works

Select the appropriate score for each of the 11 NIHSS items.
Motor arm and motor leg are scored separately for left and right sides.
The total score updates automatically as you make selections.
Severity interpretation is displayed based on established NIHSS thresholds.
Use the Reset button to clear all scores and start over.

Use cases

Emergency department triage of acute ischemic stroke patients.
Clinical education and NIHSS certification practice.
Tracking neurological change over time during stroke admission.
Telemedicine stroke consultations requiring remote scoring assistance.
Medical student and resident training on standardized stroke assessment.

Frequently Asked Questions

A score of 0 indicates no stroke symptoms. Scores of 1-4 suggest a minor stroke, 5-15 a moderate stroke, 16-20 a moderate-to-severe stroke, and 21-42 a severe stroke. Higher scores correlate with worse neurological outcomes.

Both limbs on each side are scored separately. Item 5 (Motor Arm) has left and right subscores (0-4 each), and Item 6 (Motor Leg) similarly has left and right subscores. All four contribute to the total.

This tool is for educational and reference purposes only. Official NIHSS certification requires formal training and direct patient assessment. Do not use this tool as a substitute for certified clinical evaluation.

The maximum score is 42, accounting for all 11 items including the bilateral motor arm and motor leg subscores.

Yes. Items such as level of consciousness (1a), gaze (2), visual fields (3), and facial palsy (4) can be assessed even in unconscious patients using observed responses and stimulation techniques as defined in official NIHSS guidelines.

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Summary How it works Use cases FAQ

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Nihss Stroke Scale Modified Rankin Scale Glasgow Coma Scale

Last updated: 2026-09-30 · Reviewed by Nham Vu