NIHSS Stroke Scale Calculator

NIH Stroke Scale (NIHSS) for stroke severity (0–42).

For educational and clinical reference. Not a substitute for medical judgment. See the medical disclaimer.
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Interpretation
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References

  1. Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870.

What is NIHSS Stroke Scale?

The NIH Stroke Scale (NIHSS) is a 15-item standardized neurologic examination that quantifies the severity of acute ischemic stroke. Developed by Brott et al. in 1989 at the University of Cincinnati and adopted by NINDS for thrombolysis trials, it assesses level of consciousness, gaze, visual fields, facial palsy, motor and sensory function, ataxia, language, dysarthria, and extinction. Scores range from 0 (no deficit) to 42 (maximum severity): 1–4 is minor, 5–15 moderate, 16–20 moderate-to-severe, and 21–42 severe. The NIHSS guides decisions on intravenous tPA, endovascular thrombectomy, and is reassessed at 2 h, 24 h, and discharge.

How to use

  1. Examine each of the 15 NIHSS items.
  2. The total (0–42) and severity category update instantly.
  3. Re-score on arrival, post-treatment, at 24 h, and at discharge.

Frequently asked questions

What is the NIHSS?

The National Institutes of Health Stroke Scale is a 15-item neurologic exam quantifying stroke severity from 0 (no symptoms) to 42 (severe).

How does NIHSS guide treatment?

NIHSS helps decide on IV thrombolysis and endovascular therapy. Higher scores generally support more aggressive therapy in eligible patients; very mild deficits (NIHSS < 5) may not benefit from thrombolysis.

When should NIHSS be reassessed?

At arrival, post-treatment, 24 hours, and at discharge — and after any clinical change. Trends are more informative than absolute values.

Limitations?

NIHSS underweights posterior circulation strokes and right-hemisphere syndromes. A "low NIHSS" does not always mean a non-disabling stroke.

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