NIH Stroke Scale

Question 1

How many items are in the NIH stroke scale?

Answer 1

11

Question 2

Each item receives a score between __ and __.

The maximum possible score is ___.

Answer 2

Each item receives a score between 0 and 4.

The maximum possible score is 42, with the minimum score being zero.

Question 3

What are the cut-offs for stroke severity?

Answer 3

0 - No stroke symptoms
1-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate-to-severe stroke
21-42 Severe stroke

Question 4

List the 11 items that comprise the scale

Answer 4

1. Level of consciousness
2. Horizontal eye movement
3. Visual field test
4. Facial palsy
5. Motor arm
6. Motor leg
7. Limb ataxia
8. Sensory
9. Language
10. Speech
11. Extinction and Inattention

Question 5

What are the component parts of LOC that are tested?

Answer 5

a. LOC Responsiveness
b. LOC Questions
c. LOC Commands

Question 6

LOC Responsiveness

Answer 6

Scores for this item are assigned by the medical practitioner based the the level of stimulation required to arouse the patient.

Question 7

How is LOC Responsive scored?

Answer 7

0 - Alert; responsive
1 - Not alert; verbally arousable or aroused by minor stimulation to obey, answer, or respond
2 - Not alert; only responsive repeated or strong and painful stimulation
3 - Totally unresponsive; responds only with reflexes or is areflexic

Question 8

Special considerations for LOC Responsiveness testing

Answer 8

If a patient scores 3 in this factor, the default coma scores should be used when applicable

Question 9

LOC Questions

Answer 9

Patient is verbally asked his or her age and the name of the current month. The patient must answer each question 100% correct without help to get credit.

Question 10

How is LOC Questions scored?

Answer 10

0 - Correctly answers both questions
1 - Correctly answers one question
2 - Does not correctly answer either question

Question 11

What is the Default Coma Score for LOC Questions?

Answer 11

2

Question 12

LOC Questions: what if a patient is unable to speak?

Answer 12

Patients unable to speak are allowed to write the answer.

Question 13

LOC Questions: special considerations

Answer 13

• Aphasic patients or patients in a stuporous state who are unable to understand the questions receive a score of 2.
• Patients who are to talk due to trauma, dysarthria, language barrier, or intubation are given a score of 1.

Question 14

LOC Commands

Answer 14

The patient is instructed to first open and close his /her eyes and then grip and release his/her hand. The commands can only be repeated once. A patient’s attempt is regarded as successful if an attempt is made but is incomplete due to weakness.

Question 15

How is LOC Commands scored?

Answer 15

0 - Correctly performs both tasks
1 - Correctly performs 1 task
2 - Does not correctly perform either task

Question 16

LOC Commands:

What if the patient cannot use their hands?

Answer 16

The hand grip command can be replaced with any other simple one-step command if the patient cannot use their hands.
(e.g., patients with trauma, amputations, or other physical impediments)

Question 17

LOC Commands:

What if the patient does not understand the command?

Answer 17

If the patient does not understand the command, the command can be visually demonstrated without an impact on the score.