NIHSS Calculator

Last edited and medically reviewed by Alaric Steinmetz on 10.01.2025

NIHSS Score

Level of consciousness

Alert, answers questions accurately. (0 points)

Drowsy, arousable with mild stimulation. (1 point)

Obtunded, requires repeated stimulation or is lethargic and responds to painful stimulation with purposeful motor activity. (2 points)

Comatose, does not respond or responds only with a motor reflex. (3 points)

Level of consciousness: questions

Ask the patient for the current month and their age.

Both answers correct (0 points)

One answer correct, or the patient cannot speak because of dysarthria or intubation. (1 point)

Neither answer correct; aphasic or stuporous patient. (2 points)

Level of consciousness: commands

Ask the patient to open and close their eyes, then open and close the unaffected hand (if the hand is not functional, another command should be given).

Both commands performed. (0 points)

One command performed correctly. (1 point)

No command performed correctly. (2 points)

Best gaze

Test horizontal eye movements only.

No gaze palsy. (0 points)

Partial gaze palsy. Abnormal in both eyes but improved with the oculocephalic maneuver, or abnormal in one eye. (1 point)

Forced deviation or complete gaze palsy of both eyes. (2 points)

Visual fields

Finger confrontation testing of all 4 quadrants.

Normal or monocular blindness without a visual field deficit in the other eye. (0 points)

Quadrantanopia (1 point)

Complete hemianopia (2 points)

Blindness or cortical blindness. (3 points)

Facial palsy

Ask the patient to smile, then close their eyes. If the command is not understood: use pantomime or assess facial symmetry in response to a painful stimulus.

Normal symmetrical movement. (0 points)

Minor paresis: flattened nasolabial fold, asymmetry on smiling. (1 point)

Complete or near-complete paralysis of the lower face. (2 points)

Complete paralysis of the lower and upper face. (3 points)

Motor function of the right arm

Hold the right arm at 90 degrees when sitting or 45 degrees when supine for 10 seconds.

No drift within 10 seconds. (0 points)

Drifts before 10 seconds but does not hit the support surface. (1 point)

Patient can hold the arm but cannot fully extend it, or the arm drifts down and hits the support surface. (2 points)

Unable to lift the arm against gravity. (3 points)

No movement possible, plegia. (4 points)

Unable to assess, for example due to amputation. (0 points)

Motor function of the left arm

Hold the left arm at 90 degrees when sitting or 45 degrees when supine for 10 seconds.

No drift within 10 seconds. (0 points)

Drifts before 10 seconds but does not hit the support surface. (1 point)

Patient can hold the arm but cannot fully extend it, or the arm drifts down and hits the support surface. (2 points)

Unable to lift the arm against gravity. (3 points)

No movement possible, plegia. (4 points)

Unable to assess, for example due to amputation. (0 points)

Motor function of the right leg

Hold the right leg at 30 degrees while supine for 5 seconds.

No drift within 5 seconds. (0 points)

Drifts before 5 seconds but does not hit the support surface. (1 point)

Partial effort against gravity. Patient can hold the leg but cannot fully extend it, or the leg drifts down and hits the support surface. (2 points)

Unable to lift the leg against gravity. (3 points)

No movement possible, plegia. (4 points)

Unable to assess, for example due to amputation. (0 points)

Motor function of the left leg

Hold the left leg at 30 degrees while supine for 5 seconds.

No drift within 5 seconds. (0 points)

Drifts before 5 seconds but does not hit the support surface. (1 point)

Partial effort against gravity. Patient can hold the leg but cannot fully extend it, or the leg drifts down and hits the support surface. (2 points)

Unable to lift the leg against gravity. (3 points)

No movement possible, plegia. (4 points)

Unable to assess, for example due to amputation. (0 points)

Ataxia

Perform finger-to-nose and heel-to-shin testing bilaterally with the eyes open. Do not test if the patient is not fully alert or has plegia.

No ataxia or unable to assess, for example due to plegia. (0 points)

Ataxia present in one limb. (1 point)

Ataxia present in two or more limbs. (2 points)

Sensory

Test with a sharp wooden stick on the face, arm, trunk, and leg. In patients with impaired alertness, assess with a painful stimulus.

Normal sensation. (0 points)

Partial sensory loss. Touch is weaker on one side or the patient responds only to painful stimuli. (1 point)

Severe or complete sensory loss. (2 points)

Language

Normal language. (0 points)

Mild to moderate aphasia: paraphasias or word substitutions. (1 point)

Severe aphasia; communication largely impossible. (2 points)

Mute, global aphasia. (3 points)

Dysarthria

Normal articulation or unable to assess. (0 points)

Mild to moderate dysarthria: slurring of some words. (1 point)

Nearly unintelligible. (2 points)

Neglect

No neglect. (0 points)

Visual, tactile, auditory, spatial, or personal "inattention" or "extinction" with bilateral simultaneous stimulation in one of the sensory modalities. (1 point)

Severe hemispatial "inattention" or "extinction" in more than one modality. For example, the patient does not recognize their own hand or orients only to one side of the space. (2 points)