age 1 of 25
NIH Stroke Scale – All Test Groups A-F (patients 1-6)
Answer keyUpdated
Double simultaneous stimulation is performed at this point. If
there is extinction, patient receives a 1, and the results are used
to respond to item 11.
What are the results? ......ANSWER........0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
How to assess facial palsy? ......ANSWER........Ask - or use
pantomime to encourage - the patient
,age 2 of 25
to show teeth or raise eyebrows and close eyes. Score symmetry
of grimace in response to noxious stimuli in the poorly responsive
or non-comprehending patient.
How to assess Level of Consciousness? ......ANSWER........1a.
Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit for being
close. Aphasic and stuporous patients who do not comprehend
the questions will score 2. It is important that only the initial
answer be graded and that the examiner not "help" the patient
with verbal or non-verbal cue.
1c. The patient is asked to open and close the
, age 3 of 25
eyes and then to grip and release the non-paretic hand. If the
patient does not respond to command, the task
should be demonstrated to him or her (pantomime), and the
result scored (i.e., follows none, one or two commands)
What are the results? ......ANSWER........0 = Alert; keenly
responsive.
1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is
obtunded and requires strong or painful stimulation to
make movements (not stereotyped).
NIH Stroke Scale – All Test Groups A-F (patients 1-6)
Answer keyUpdated
Double simultaneous stimulation is performed at this point. If
there is extinction, patient receives a 1, and the results are used
to respond to item 11.
What are the results? ......ANSWER........0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
How to assess facial palsy? ......ANSWER........Ask - or use
pantomime to encourage - the patient
,age 2 of 25
to show teeth or raise eyebrows and close eyes. Score symmetry
of grimace in response to noxious stimuli in the poorly responsive
or non-comprehending patient.
How to assess Level of Consciousness? ......ANSWER........1a.
Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit for being
close. Aphasic and stuporous patients who do not comprehend
the questions will score 2. It is important that only the initial
answer be graded and that the examiner not "help" the patient
with verbal or non-verbal cue.
1c. The patient is asked to open and close the
, age 3 of 25
eyes and then to grip and release the non-paretic hand. If the
patient does not respond to command, the task
should be demonstrated to him or her (pantomime), and the
result scored (i.e., follows none, one or two commands)
What are the results? ......ANSWER........0 = Alert; keenly
responsive.
1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is
obtunded and requires strong or painful stimulation to
make movements (not stereotyped).
