What does an NIHSS score of 0 mean?

A score of 0 indicates no detectable neurological deficit. Scores of 1–4 are generally classified as minor stroke, 5–15 moderate, 16–20 moderate-to-severe, and 21–42 severe.

Is this tool a substitute for a trained clinician?

No. The NIHSS must be administered by a trained examiner who directly observes the patient. This calculator is an educational and documentation aid, not a replacement for bedside evaluation.

Why do some items have only 2 response options and others have 5?

The NIHSS uses item-specific scales to capture the clinical range most relevant to each domain. For example, facial palsy is graded 0–3, while arm motor function is graded 0–4 plus one untestable code.

What is the maximum possible score?

The theoretical maximum is 42, though scores above 25 are uncommon and usually indicate very extensive hemispheric or basilar artery strokes.

Does a higher score always mean a worse outcome?

Higher admission NIHSS strongly correlates with worse 90-day functional outcome on average, but individual prognosis depends on stroke location, treatment, age, and comorbidities.

NIHSS Stroke Score Calculator

Score stroke severity from 0 (normal) to 42 (severe) across 11 neurological domains using the NIH Stroke Scale.

Total NIHSS Score

out of 42

No Deficit

042

Summary

The NIH Stroke Scale (NIHSS) is a standardized 11-item neurological assessment used by clinicians to quantify stroke severity at admission and during follow-up. Scores range from 0 (no detectable neurological deficit) to 42 (maximally severe), with higher scores indicating greater impairment. This tool walks you through all 11 domains — consciousness, gaze, visual fields, facial palsy, motor function, ataxia, sensation, language, dysarthria, and extinction — and calculates your total instantly.

How it works

Select the most appropriate response for each of the 11 NIHSS items.
Each item is scored on its own scale (0–4 for motor, 0–3 for most others).
The running total updates in real time as you make selections.
Review the severity band (Minor, Moderate, Severe, etc.) shown at the top.
Use the Reset button to clear all selections and start over.
Print or copy the final score summary for clinical documentation.

Use cases

Emergency triage: rapidly quantify deficit at stroke onset.
Track neurological changes during acute hospital admission.
Determine eligibility for thrombolysis or thrombectomy.
Document baseline severity for prognosis and outcome research.
Teaching tool for medical students learning stroke assessment.
Telemedicine stroke evaluation with remote guidance.
Quality improvement audits requiring standardized scoring.
Rehabilitation planning based on admission deficit profile.

Frequently Asked Questions

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