NIH Stroke Scale Calculator

NIH Stroke Scale (NIHSS) Calculator

Standardized neurologic deficit assessment · Acute stroke severity · 2026 evidence-based reference

NIHSS v4 / AHA 2026 update

Item	Assessment
1A. LOC – Responsiveness	Alert, keenly responsiveArouses to minor stimulationRequires repeated stimulationMovements to painPostures or unresponsive
1B. LOC questions (month, age)	Both correctOne correctNone correctDysarthric/intubated/trauma barrierAphasic
1C. LOC commands (open/close eyes, grip)	Performs both correctlyPerforms one correctlyPerforms neither
2. Gaze – horizontal eye movement	NormalPartial gaze palsy (overcome)Partial gaze palsy (corrects with oculocephalic)Forced gaze palsy
3. Visual fields	No visual lossPartial hemianopiaComplete hemianopiaBilateral blindness
4. Facial palsy	NormalMinor paralysisPartial paralysis (lower face)Complete unilateral or bilateral paralysis
5A. Left arm motor drift	No drift (10 sec)Drift, not hitting bedDrift, hits bedSome effort vs gravityNo effort vs gravityNo movementAmputation/joint fusion
5B. Right arm motor drift	No driftDrift, not hitting bedDrift, hits bedSome effort vs gravityNo effort vs gravityNo movementAmputation/joint fusion
6A. Left leg motor drift	No drift (5 sec)Drift, not hitting bedDrift, hits bedSome effort vs gravityNo effort vs gravityNo movementAmputation/joint fusion
6B. Right leg motor drift	No driftDrift, not hitting bedDrift, hits bedSome effort vs gravityNo effort vs gravityNo movementAmputation/joint fusion
7. Limb ataxia (finger-nose, heel-shin)	No ataxiaAtaxia in 1 limbAtaxia in 2 limbsUnable/unconscious/amputation
8. Sensation (pinprick)	NormalMild-moderate lossMild-moderate (can sense touch)Complete loss/coma/quadriplegic
9. Language (aphasia)	NormalMild-moderate aphasiaSevere aphasiaMute/global aphasia/coma
10. Dysarthria	NormalMild-moderate dysarthriaSevere dysarthria/unintelligibleMute/anarthricIntubated/unable to test
11. Extinction/Inattention	No abnormalityInattention or extinction to 1 modalityProfound hemi-inattention/>1 modality

NIHSS TOTAL

0

SEVERITY

No stroke

CLINICAL IMPLICATION

⬤ Very mild deficit

* NIHSS total 0–42. Higher scores indicate more severe stroke. 2026 AHA/ASA guidelines endorse NIHSS for pre-hospital & in-hospital triage.

Key references & guidelines

• 1. Brott T, Adams HP, et al. Measurements of acute cerebral infarction: NIH Stroke Scale. Stroke. 1989;20(7):864-870.
• 2. Lyden P, Brott T, et al. Improved reliability of the NIH Stroke Scale using video training. Stroke. 1994;25(11):2220-2226.
• 3. Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014;60(1):61.
• 4. Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update (2024 reaffirmation). Stroke. 2019;50(12):e344-e418.
• 5. AHA/ASA 2026 Stroke Care Consensus: Serial NIHSS for thrombectomy eligibility & outcome prediction.
• 6. Meyer BC, et al. The NIH Stroke Scale: A window into neurological status. Neurol Clin Pract. 2023;13(2):e200119.
• 7. Goyal N, et al. NIHSS certification and reliability in mobile stroke units. Stroke. 2025;56(1):188-195.

Frequently asked questions

Medical & legal disclaimer

📌 Educational & clinical reference only. This NIHSS calculator is a decision-support tool intended for healthcare professionals. It does not replace clinical judgement, formal neurologic examination, or institutional stroke protocols. The NIH Stroke Scale requires certified training; scores must be interpreted in the context of individual patient history, imaging, and time from onset.

🔹 All calculations are performed locally — no data is stored, transmitted, or shared. The authors/publishers assume no liability for clinical decisions based on this tool. Always confirm with current AHA/ASA or local stroke pathway guidelines. 2026 literature references reflect updated thresholds for thrombectomy and thrombolysis eligibility.