Transcript Video
NIH Stroke Scale
The Good, The Bad, and The Ugly
Press F5 for sound on the presentation
NIHSS
Level of consciousness
• • • •
Alert Drowsy Stupor Coma 0 points 1 point 2 points 3 points
NIHSS
Questions Month/Age
• • •
Answer both correctly Answers one correctly None are correct 0 points 1 point 2 points
NIHSS
Response to 2 Commands
• • •
Follows 2 command correctly Follows 1 command correctly Cannot follow either command 0 points 1 point 2 points
NIHSS
Best Gaze
• • •
Normal Partial gaze to one side Forced gaze to one side 0 points 1 point 2 points
NIHSS
Visual Fields
• • • •
No visual loss Partial hemianopsia Complete hemianopsia Bilateral visual loss 0 points 1 point 2 points 3 points
NIHSS
Facial Motor Function
• • • •
No weakness Minor unilateral weakness Partial unilateral weakness 0 points 1 point 2 points Complete uni or bilateral weakness 3 points
NIHSS
Upper Extremity Motor Function (Right and Left Scored Independently)
• • • • •
Normal Drift Some effort against gravity No effort against gravity No movement 0 points 1 point 2 points 3 points 4 points
NIHSS
Lower Extremity Motor Function
(
Right and Left Scored Independently)
• • • • •
Normal Drift Some effort against gravity No effort against gravity No movement 0 points 1 point 2 points 3 points 4 points
NIHSS
Extremity Ataxia (Cannot Be Tested in Presence of Paresis)
• • •
No ataxia Ataxia in 1 extremity Ataxia in 2 extremities 0 points 1 point 2 points
NIHSS
Sensory Loss
• • •
Normal Mild to moderate loss Severe to total loss 0 points 1 point 2 points
NIHSS
Language
• • • •
No aphasia Mild to moderate aphasia Severe aphasia Mute 0 points 1 point 2 points 3 points
NIHSS
Articulation (Dysarthia)
• • •
Normal Mild to moderate Severe 0 points 1 point 2 points
NIHSS
Extinction/Inattention
• • •
No abnormality Extinction to one modality Extinction to 2 modalities 0 points 1 point 2 points
The Good
• • •
Reliable
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Interrater reliability confirmed Valid Time efficient
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Original trial had a 6 minute average Cell phone with video capability takes 38 seconds longer than bedside examination
The Bad
• • •
Tendency to favor speech/language function over higher integrated sensory function
–
L MCA infarcts average 4 points higher than R MCA infarcts Some items represent redundancy
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Ataxia with gross motor function Dysarthria with aphasia Too often ataxia is over represented
The Ugly
• •
Brainstem/cerebellar function overly minimized Not a good scale for the “dizzy plus” patient