NIHSS Latest Update 100 Verified

NIHSS Latest Update 100% Verified

NIHSSI ✔✔The National Institutes of Health Stroke Scale International

Important Conventions ✔✔Administer scale items in their exact order Avoid coaching patient Accept patients first attempt Score only what patient does Be consistent Include all deficits in scoring

1A. Level of Consciousness (LOC) ✔✔Overall impression of alertness.

1A. Level of Consciousness (LOC) Scoring ✔✔0 = Alert.

• = Not alert; aroused with minor verbal stimulation.

• = Not alert; requires strong or painful stimulation. 1 / 2

• = Reflex movements only or totally unresponsive.

1A. Level of Consciousness (LOC) Exam ✔✔Ask patient questions about circumstances of admission. Stimulate patient by patting or tapping patient. Or noxious stimulation such as pinching or stern rub to check level of consciousness.

1A. Level of Consciousness (LOC) Assessment ✔✔LOC is the only item allowed to go back and change a score. If it is difficult to score between 1 or 2, continue with medical history questions until confident in assigning a score. Score must be chosen even if confronted with obstacles such as ET tube, language barrier, or oral tracheae trauma or bandages.

Score 0, keenly responsive.

Score 2, repeated verbal stimulation to attend, strong painful noxious stimulation to make movements.

Score of 3 is generally considered to be in a coma. Score of 3 requires noxious painful stimuli by sternal rub. Only reflexive posturing movements in response to painful noxious stimuli. Requires

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