National Institute of Health Stroke Scale

The National Institute of Health Stroke Scale

A stroke can affect any part of the brain, depending on which blood vessels are affected. Since a stroke can cause a variety of symptoms, including weakness, trouble speaking, coordination difficulties, vision loss, confusion or decreased sensation, among a wide-range of other neurological problems, it may seem difficult to precisely describe how severe a stroke is.

A stroke victim could experience mild weakness of the arm and leg on both sides of the body and still maintain the ability to walk and even drive after a stroke while another stroke victim may experience severe weakness of just one leg on one side of the body with a consequent complete loss of walking ability. Similarly, for one person, a stroke can cause an area of vision loss with normal cognitive insight, allowing the stroke survivor to learn how to watch out for missed objects in a tiny area of vision loss, while for another person, a stroke can actually cause such a lack of cognitive insight that the stroke survivor is unaware of the problem and doesn’t even realize that he or she has a handicap.

There are some tools that help health care professionals communicate in a uniform way to describe the condition of a stroke patient and the severity of a stroke at a given time. One of these tools include the National Institute of Health Stroke Scale, which was developed as a mechanism of assessment for research experiments, such as those used to help evaluate the effectiveness of new stroke treatments.

But, rating stroke patients according to the National Institute of Health Stroke Scale is often used to maintain consistently between the stroke evaluations of one patient over time or to develop and stick to treatment plans designed for stroke patients. It can help with communication between providers who care for stroke patients so that everyone is on the same page.

When the National Institute of Health Stroke Scale is used, a point system is utilized to label a stroke as minor to moderate to severe.

15 different neurological criteria are used to evaluate stroke severity, each with a rating scale ranging from 0-2 to 0-4. The total possible points can add up to 0, indicating no stroke up to to 42, indicating a severe stroke.

The Criteria Used

  • Level of consciousness based on patient responsiveness, scaled 0-3
  • Level of consciousness based on whether the patient can correctly state his or her age and the current month, scaled 0-2
  • Level of consciousness based on whether the patient can follow the simple requests of grasping and releasing the examiner’s hand, scaled 0-2
  • Side to side eye movements, scaled 0-2
  • Vision, with attention to vision in all areas of vision, scaled 0-3
  • Facial movements and symmetry, scaled 0-3
  • Arm strength and movements scaled 0-4 for each side
  • Leg strength and movements scaled 0-4 for each side
  • Coordination of movements scaled 0-2
  • Sensation of the body scaled 0-2
  • Language and the understanding of language, including the expected and appropriate use of words scaled 0-3
  • Speech clarity and production of words scaled 0-2
  • Attention scaled 0-2

Trained professionals are experienced in neurological examination of stroke patients and in using the National Institute of Health Stroke Scale as one of the ways to report the patient’s condition. Comparisons can be used over time to monitor whether the patient is worsening or improving. Treatment protocols can be more easily applied using a uniform rating of the stroke severity.

Patients have access to all medical records. Your medical records may contain information about your National Institute of Health Stroke Scale. You can see how your condition has changed over time by looking at your chart and your stroke rating.

Sources

National Institute of Health Stroke Scale

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