National Institutes of Health Stroke Scale (NIHSS)

Clinical context

Note: - For Level of Consciousness, observe the patient’s alertness, ask two questions (e.g., 'What month is it?' and 'How old are you?'), and test simple commands (open/close eyes, grip/release hand). - For Best Gaze, have the patient follow a moving object horizontally. - For Visual Fields, perform a confrontation test in all quadrants and note any partial or complete field loss. - For Facial Palsy, ask the patient to smile, raise eyebrows, and close eyes to check for asymmetry. - For Motor responses, test each arm by having it extended (90° if sitting or 45° if supine) for 10 seconds and each leg by raising it to 30° for 5 seconds, noting any drift, decreased effort, or absence of movement. - For Limb Ataxia, have the patient perform finger-to-nose and heel-to-shin tests, scoring only when incoordination exceeds weakness. - For Best Language, assess the ability to describe a picture, name objects, or read sentences, scoring based on fluency and comprehension. - For Dysarthria, ask the patient to repeat words to evaluate speech clarity. - Finally, for Extinction and Inattention, use simultaneous stimulation to check for neglect.