Level of Consciousness
1a LOC
0 — Alert, responsive
1 — Not alert, arousable by stimulation
2 — Not alert, requires repeated stimulation
3 — Unresponsive/reflexive only
1b LOC Questions (age & month)
0 — Answers both correctly
1 — Answers one correctly
2 — Answers neither
1c LOC Commands (grip & eyes)
0 — Performs both tasks
1 — Performs one task
2 — Performs neither
2 Best Gaze
0 — Normal
1 — Partial gaze palsy
2 — Forced gaze deviation
3 Visual Fields
0 — No visual loss
1 — Partial hemianopia
2 — Complete hemianopia
3 — Bilateral hemianopia
4 Facial Palsy
0 — Normal symmetrical movement
1 — Minor paralysis
2 — Partial paralysis
3 — Complete paralysis
Motor
5a Motor Arm — Left
0 — No drift
1 — Drift before 10 sec
2 — Falls, some effort vs gravity
3 — No effort against gravity
4 — No movement
5b Motor Arm — Right
0 — No drift
1 — Drift before 10 sec
2 — Falls, some effort vs gravity
3 — No effort against gravity
4 — No movement
6a Motor Leg — Left
0 — No drift
1 — Drift before 5 sec
2 — Falls, some effort vs gravity
3 — No effort against gravity
4 — No movement
6b Motor Leg — Right
0 — No drift
1 — Drift before 5 sec
2 — Falls, some effort vs gravity
3 — No effort against gravity
4 — No movement
7 Limb Ataxia
0 — Absent
1 — Present in one limb
2 — Present in two limbs
8 Sensory
0 — Normal
1 — Mild-moderate loss
2 — Severe or total loss
Language, Speech & Attention
9 Best Language
0 — Normal
1 — Mild-moderate aphasia
2 — Severe aphasia
3 — Mute / global aphasia
10 Dysarthria
0 — Normal
1 — Mild-moderate
2 — Severe / unintelligible / mute
11 Extinction / Inattention
0 — No abnormality
1 — Inattention to one modality
2 — Profound hemi-inattention
Calculate NIHSS
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NIHSS Interpretation
Score Severity Notes
0 No stroke symptoms Baseline normal 1–4 Minor stroke Consider tPA if in window 5–15 Moderate tPA eligible (if criteria met) 16–20 Moderate-severe tPA/thrombectomy consideration 21–42 Severe Aggressive intervention warranted
Total = sum of all 11 items (0–42)
Thrombolysis Note: NIHSS is one component of tPA eligibility. Consider: time of onset, CT findings, BP, coagulation, age, and contraindications. NIHSS <4 (minor stroke) — weigh risks carefully. NIHSS >22 — high haemorrhage risk.
For clinical decision support only. Not a substitute for professional medical judgment.
