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NIH Stroke Scale The Good, The Bad, and The Ugly

NIH Stroke Scale The Good, The Bad, and The Ugly. Press F5 for sound on the presentation. NIHSS Level of consciousness. Alert 0 points Drowsy 1 point Stupor 2 points Coma 3 points.

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NIH Stroke Scale The Good, The Bad, and The Ugly

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  1. NIH Stroke ScaleThe Good, The Bad, and The Ugly Press F5 for sound on the presentation

  2. NIHSSLevel of consciousness • Alert 0 points • Drowsy 1 point • Stupor 2 points • Coma 3 points

  3. NIHSSQuestions Month/Age • Answer both correctly 0 points • Answers one correctly 1 point • None are correct 2 points

  4. NIHSSResponse to 2 Commands • Follows 2 command correctly 0 points • Follows 1 command correctly 1 point • Cannot follow either command 2 points

  5. NIHSSBest Gaze • Normal 0 points • Partial gaze to one side 1 point • Forced gaze to one side 2 points

  6. NIHSSVisual Fields • No visual loss 0 points • Partial hemianopsia 1 point • Complete hemianopsia 2 points • Bilateral visual loss 3 points

  7. NIHSSFacial Motor Function • No weakness 0 points • Minor unilateral weakness 1 point • Partial unilateral weakness 2 points • Complete uni or bilateral weakness 3 points

  8. NIHSSUpper Extremity Motor Function(Right and Left Scored Independently) • Normal 0 points • Drift 1 point • Some effort against gravity 2 points • No effort against gravity 3 points • No movement 4 points

  9. NIHSSLower Extremity Motor Function(Right and Left Scored Independently) • Normal 0 points • Drift 1 point • Some effort against gravity 2 points • No effort against gravity 3 points • No movement 4 points

  10. NIHSSExtremity Ataxia(Cannot Be Tested in Presence of Paresis) • No ataxia 0 points • Ataxia in 1 extremity 1 point • Ataxia in 2 extremities 2 points

  11. NIHSSSensory Loss • Normal 0 points • Mild to moderate loss 1 point • Severe to total loss 2 points

  12. NIHSSLanguage • No aphasia 0 points • Mild to moderate aphasia 1 point • Severe aphasia 2 points • Mute 3 points

  13. NIHSSArticulation (Dysarthia) • Normal 0 points • Mild to moderate 1 point • Severe 2 points

  14. NIHSSExtinction/Inattention • No abnormality 0 points • Extinction to one modality 1 point • Extinction to 2 modalities 2 points

  15. The Good • Reliable • Interrater reliability confirmed • Valid • Time efficient • Original trial had a 6 minute average • Cell phone with video capability takes 38 seconds longer than bedside examination

  16. 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 • Ataxia with gross motor function • Dysarthria with aphasia • Too often ataxia is over represented

  17. The Ugly • Brainstem/cerebellar function overly minimized • Not a good scale for the “dizzy plus” patient

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