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NIHSS (NIH Stroke Scale)

Quantifies acute stroke neurological deficit in 15 items (0 to 42 points). Applied on arrival, before and after reperfusion and during follow-up.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

NIHSS: 15 items, numeric total 0–42; UN in items permitted by the full form and NINDS CDEs; an assessment with UN is incomplete here, with no total or conversion to 0

Structured assessment of neurological impairment in stroke. The edition and instructions for each item must be checked in the corresponding form. The published Brazilian adaptation and interexaminer agreement do not amount to clinical validation of this implementation or its new translations. UN is a nonnumeric category in the specific situations described for the motor, ataxia and dysarthria items of the full form. The interface allows it to be selected and flags the assessment as incomplete, without a total score or converting UN to 0. Document the reason on the corresponding clinical form. This safeguard does not validate complete administration, dependencies between items, language materials or the authored translations.

Required fields: 0/15 completed

Complete all required fields. Optional fields are marked.

1a. Level of consciousness required

1b. Questions: month and age required

1c. Commands: open and close eyes; grip and release the nonparetic hand required

2. Best gaze (horizontal) required

3. Visual fields required

4. Facial palsy required

5a. Left arm motor function (90° sitting or 45° supine, for 10 s) required

5b. Right arm motor function required

6a. Left leg motor function (30° supine, for 5 s) required

6b. Right leg motor function required

7. Limb ataxia (finger-to-nose and heel-to-shin) required

8. Sensory function (pinprick) required

9. Best language required

10. Dysarthria required

11. Extinction and inattention (neglect) required

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Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

1a. Level of consciousness
1b. Questions: month and age
1c. Commands: open and close eyes; grip and release the nonparetic hand
2. Best gaze (horizontal)
3. Visual fields
4. Facial palsy
5a. Left arm motor function (90° sitting or 45° supine, for 10 s)
5b. Right arm motor function
6a. Left leg motor function (30° supine, for 5 s)
6b. Right leg motor function
7. Limb ataxia (finger-to-nose and heel-to-shin)
8. Sensory function (pinprick)
9. Best language
10. Dysarthria
11. Extinction and inattention (neglect)

5/5 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Add the 15 items in scale order (do not return to correct earlier items). Score what the patient does, not what the examiner thinks the patient can do. Total: 0 to 42.

UN is a nonnumeric category in the specific situations described for the motor, ataxia and dysarthria items of the full form. The interface allows it to be selected and flags the assessment as incomplete, without a total score or converting UN to 0. Document the reason on the corresponding clinical form. This safeguard does not validate complete administration, dependencies between items, language materials or the authored translations.

References

Identifier: nihss

Original clinical content: Brazilian Portuguese.

Method version

NIHSS: 15 items, numeric total 0–42; UN in items permitted by the full form and NINDS CDEs; an assessment with UN is incomplete here, with no total or conversion to 0

nihss@native-2026-10-04+ab5c3638beda

NINDS official common data element: permitted numeric and UN categories; not a clinical approval.

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (5)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

1a. Level of consciousness: 0 – Alert, responds promptly
1b. Questions: month and age: 0 – Answers both correctly
1c. Commands: open and close eyes; grip and release the nonparetic hand: 0 – Performs both tasks
2. Best gaze (horizontal): 0 – Normal
3. Visual fields: 0 – No visual loss
4. Facial palsy: 0 – Normal and symmetric movements
5a. Left arm motor function (90° sitting or 45° supine, for 10 s): 0 – No drift for 10 s
5b. Right arm motor function: 0 – No drift for 10 s
6a. Left leg motor function (30° supine, for 5 s): 0 – No drift for 5 s
6b. Right leg motor function: 0 – No drift for 5 s
7. Limb ataxia (finger-to-nose and heel-to-shin): 0 – Absent
8. Sensory function (pinprick): 0 – Normal
9. Best language: 0 – Normal, no aphasia
10. Dysarthria: 0 – Normal articulation
11. Extinction and inattention (neglect): 0 – No abnormality

{
  "n1a": "0",
  "n1b": "0",
  "n1c": "0",
  "n2": "0",
  "n3": "0",
  "n4": "0",
  "n5a": "0",
  "n5b": "0",
  "n6a": "0",
  "n6b": "0",
  "n7": "0",
  "n8": "0",
  "n9": "0",
  "n10": "0",
  "n11": "0"
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 2

reference-002

Inputs

4. Facial palsy: 1 – Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
10. Dysarthria: 1 – Mild to moderate (understandable with difficulty)
1a. Level of consciousness: 0 – Alert, responds promptly
1b. Questions: month and age: 0 – Answers both correctly
1c. Commands: open and close eyes; grip and release the nonparetic hand: 0 – Performs both tasks
2. Best gaze (horizontal): 0 – Normal
3. Visual fields: 0 – No visual loss
5a. Left arm motor function (90° sitting or 45° supine, for 10 s): 0 – No drift for 10 s
5b. Right arm motor function: 0 – No drift for 10 s
6a. Left leg motor function (30° supine, for 5 s): 0 – No drift for 5 s
6b. Right leg motor function: 0 – No drift for 5 s
7. Limb ataxia (finger-to-nose and heel-to-shin): 0 – Absent
8. Sensory function (pinprick): 0 – Normal
9. Best language: 0 – Normal, no aphasia
11. Extinction and inattention (neglect): 0 – No abnormality

{
  "n4": "1",
  "n10": "1",
  "n1a": "0",
  "n1b": "0",
  "n1c": "0",
  "n2": "0",
  "n3": "0",
  "n5a": "0",
  "n5b": "0",
  "n6a": "0",
  "n6b": "0",
  "n7": "0",
  "n8": "0",
  "n9": "0",
  "n11": "0"
}

Expected result

{
  "score": 2,
  "level": "mid",
  "verdict": "leve"
}

Actual result

{
  "score": 2
}

Case 3

reference-003

Inputs

1a. Level of consciousness: 1 – Not alert, but arouses with minimal stimulation
3. Visual fields: 2 – Complete hemianopia
4. Facial palsy: 2 – Partial paralysis (total or near-total lower facial paralysis)
5a. Left arm motor function (90° sitting or 45° supine, for 10 s): 3 – No effort against gravity
6a. Left leg motor function (30° supine, for 5 s): 2 – Some effort against gravity (falls to the bed)
9. Best language: 1 – Mild to moderate aphasia
10. Dysarthria: 1 – Mild to moderate (understandable with difficulty)
1b. Questions: month and age: 0 – Answers both correctly
1c. Commands: open and close eyes; grip and release the nonparetic hand: 0 – Performs both tasks
2. Best gaze (horizontal): 0 – Normal
5b. Right arm motor function: 0 – No drift for 10 s
6b. Right leg motor function: 0 – No drift for 5 s
7. Limb ataxia (finger-to-nose and heel-to-shin): 0 – Absent
8. Sensory function (pinprick): 0 – Normal
11. Extinction and inattention (neglect): 0 – No abnormality

{
  "n1a": "1",
  "n3": "2",
  "n4": "2",
  "n5a": "3",
  "n6a": "2",
  "n9": "1",
  "n10": "1",
  "n1b": "0",
  "n1c": "0",
  "n2": "0",
  "n5b": "0",
  "n6b": "0",
  "n7": "0",
  "n8": "0",
  "n11": "0"
}

Expected result

{
  "score": 12,
  "level": "mid",
  "verdict": "moderado (5 a 15"
}

Actual result

{
  "score": 12
}

Case 4

reference-004

Inputs

2. Best gaze (horizontal): 2 – Forced deviation or total gaze palsy not overcome by the oculocephalic maneuver
3. Visual fields: 2 – Complete hemianopia
4. Facial palsy: 2 – Partial paralysis (total or near-total lower facial paralysis)
5b. Right arm motor function: 4 – No movement
6b. Right leg motor function: 4 – No movement
9. Best language: 2 – Severe aphasia
1a. Level of consciousness: 0 – Alert, responds promptly
1b. Questions: month and age: 0 – Answers both correctly
1c. Commands: open and close eyes; grip and release the nonparetic hand: 0 – Performs both tasks
5a. Left arm motor function (90° sitting or 45° supine, for 10 s): 0 – No drift for 10 s
6a. Left leg motor function (30° supine, for 5 s): 0 – No drift for 5 s
7. Limb ataxia (finger-to-nose and heel-to-shin): 0 – Absent
8. Sensory function (pinprick): 0 – Normal
10. Dysarthria: 0 – Normal articulation
11. Extinction and inattention (neglect): 0 – No abnormality

{
  "n2": "2",
  "n3": "2",
  "n4": "2",
  "n5b": "4",
  "n6b": "4",
  "n9": "2",
  "n1a": "0",
  "n1b": "0",
  "n1c": "0",
  "n5a": "0",
  "n6a": "0",
  "n7": "0",
  "n8": "0",
  "n10": "0",
  "n11": "0"
}

Expected result

{
  "score": 16,
  "level": "high",
  "verdict": "moderado a grave"
}

Actual result

{
  "score": 16
}

Case 5

reference-005

Inputs

1a. Level of consciousness: 2 – Not alert, requires repeated or painful stimulation
1b. Questions: month and age: 2 – Neither correct
1c. Commands: open and close eyes; grip and release the nonparetic hand: 2 – Neither task
2. Best gaze (horizontal): 2 – Forced deviation or total gaze palsy not overcome by the oculocephalic maneuver
3. Visual fields: 2 – Complete hemianopia
4. Facial palsy: 3 – Complete paralysis (upper and lower face) on one or both sides
5b. Right arm motor function: 4 – No movement
6b. Right leg motor function: 4 – No movement
8. Sensory function (pinprick): 2 – Severe or total loss
9. Best language: 3 – Mute or global aphasia
11. Extinction and inattention (neglect): 2 – Severe hemi-inattention or in more than one modality
5a. Left arm motor function (90° sitting or 45° supine, for 10 s): 0 – No drift for 10 s
6a. Left leg motor function (30° supine, for 5 s): 0 – No drift for 5 s
7. Limb ataxia (finger-to-nose and heel-to-shin): 0 – Absent
10. Dysarthria: 0 – Normal articulation

{
  "n1a": "2",
  "n1b": "2",
  "n1c": "2",
  "n2": "2",
  "n3": "2",
  "n4": "3",
  "n5b": "4",
  "n6b": "4",
  "n8": "2",
  "n9": "3",
  "n11": "2",
  "n5a": "0",
  "n6a": "0",
  "n7": "0",
  "n10": "0"
}

Expected result

{
  "score": 28,
  "level": "high",
  "verdict": "grave (21"
}

Actual result

{
  "score": 28
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.