Interactive scorer for the NIH Stroke Scale (NINDS; Brott & Adams, Stroke, 1989):
all 15 items with bedside examination instructions — total 0–42 with severity bands,
untestable (UN) handling, and per-item breakdown. Everything runs in your browser; nothing is uploaded.
Educational screening aid for trained clinicians — not medical advice.
The NIHSS is a clinical instrument: this tool helps you add up the 15 items, it does not examine
a patient for you. Suspected stroke is an emergency: call your local emergency number
(for example 119 in Indonesia) — do not rely on a calculator.
Interactive NIHSS scorer
Score each item from your examination. Expand the instruction under each item before scoring.
Leave nothing blank — choose UN only where the item allows it.
0
No stroke symptoms NIHSS 0
Item
Finding scored
Score
Screening aid, not medical advice. Re-score over time — the trend matters more
than any single total. If this is a real patient in distress, call emergency services now.
Worked examples
1 — No deficits: all 15 items 0 → NIHSS 0
Fully alert, normal gaze, fields, face, limb strength, coordination, sensation, language, speech,
and attention. Total 0, notation NIHSS 0, band
no stroke symptoms. Remember: NIHSS 0 does not rule out stroke (posterior circulation).
2 — Minor: 1a=1 + 4=1 + 5b=1 + 10=1 → NIHSS 4
Slightly reduced alertness, minor facial droop, right-arm drift before 10 s, mild slurred speech;
all other items 0. Total 4, notation NIHSS 4, band
minor stroke (1–4).
One LOC question missed, partial gaze palsy, partial hemianopia, minor facial droop, left arm and
left leg fall before time, ataxia in one limb, mild sensory loss, mild aphasia, slurred speech,
and extinction to one modality. Total 13, notation NIHSS 13, band
moderate stroke (5–15).
4 — Maximum: every item at its worst → NIHSS 42
3+2+2+2+3+3+4+4+4+4+2+2+3+2+2 = 42, notation NIHSS 42, band
severe stroke (21–42).
Items and score ranges per the NINDS NIH Stroke Scale (Brott, Adams et al., Stroke 1989):
1a 0–3; 1b, 1c 0–2; best gaze 0–2; visual fields 0–3; facial palsy 0–3;
motor arm 5a/5b 0–4; motor leg 6a/6b 0–4; limb ataxia 0–2; sensory 0–2;
best language 0–3; dysarthria 0–2; extinction/inattention 0–2; maximum 42.
UN (untestable) contributes 0: amputation/joint fusion for motor items and ataxia, intubation or
physical barrier to speech for dysarthria; item 11 is never untestable. Coma rule (1a = 3):
sensory scores 2 and language scores 3 automatically; motor items score 4 without voluntary movement.
Severity bands 0 / 1–4 / 5–15 / 16–20 / 21–42 are the commonly used literature
convention, not part of the official scale. Item instructions are paraphrased from the official
NIHSS form (see sources).
Scope boundary: what this tool is (and isn't)
This tool = the standalone NIHSS assessment. Item-level 1a–11 scoring (0–42),
severity bands, UN handling, coma-rule guidance, and the worked examples above.
NOT a consciousness scale.Glasgow Coma Scale (E1–4 / V1–5 / M1–6,
total 3–15) measures level of consciousness for any cause — a different instrument
for a different question. NIHSS measures stroke deficits; GCS measures consciousness.
NOT a stroke-risk or disability scale.CHA2DS2-VASc estimates
stroke risk in atrial fibrillation (before any stroke); the modified Rankin Scale grades
disability months later. Determine the acute deficit severity here first.
NOT medical advice and NOT a substitute for clinical judgment, imaging, or serial examination.
See the FAQ.
The NIH Stroke Scale is a standardized 15-item neurological examination for acute stroke, developed by Thomas Brott and Harold P. Adams Jr. at the University of Cincinnati and published in Stroke in 1989. It scores level of consciousness, gaze, visual fields, facial movement, limb strength (both arms and legs), coordination, sensation, language, speech, and spatial neglect. Each item is scored 0 (normal) to 2, 3, or 4 depending on the item, and the total ranges from 0 (no measurable deficit) to 42 (maximum deficit). It is the most widely used stroke-severity scale worldwide, used for treatment decisions, prognosis, trial eligibility, and serial monitoring.
How is the NIHSS score calculated?
Score each of the 15 items (1a, 1b, 1c, 2, 3, 4, 5a, 5b, 6a, 6b, 7, 8, 9, 10, 11) and add them: NIHSS = 1a + 1b + 1c + 2 + 3 + 4 + 5a + 5b + 6a + 6b + 7 + 8 + 9 + 10 + 11. Items marked UN (untestable, e.g. an amputated limb) contribute 0 points. The maximum possible total is 42: 3+2+2+2+3+3+4+4+4+4+2+2+3+2+2. Example: alertness slightly reduced (1a=1) + minor facial droop (4=1) + right-arm drift (5b=1) + mild slurred speech (10=1) = 4, which falls in the minor-stroke band (1–4).
What do the NIHSS severity bands mean?
The commonly used bands are: 0 = no stroke symptoms, 1–4 = minor stroke, 5–15 = moderate stroke, 16–20 = moderate-to-severe stroke, and 21–42 = severe stroke. Important honesty note: these bands are a literature convention, not part of the official NIHSS scale itself, and they describe severity of neurological deficit — not a diagnosis, not a treatment order, and not a prognosis by themselves. Boundary examples: a total of 4 is minor while 5 is moderate; 15 is moderate while 16 is moderate-to-severe; 20 is moderate-to-severe while 21 is severe.
What does "UN" mean, and how are untestable items scored?
UN = untestable. An item scores UN only for specific physical reasons, and it then contributes 0 points to the total: amputation or joint fusion for the motor arm/leg items (5a, 5b, 6a, 6b) and limb ataxia (7); intubation or another physical barrier to speech for dysarthria (10). Item 11 (extinction/inattention) is never UN — it is scored only if an abnormality is present, otherwise 0. Item 7 (ataxia) scores 0 — not UN — when the patient cannot understand instructions or is paralyzed. This calculator displays totals with UN noted, e.g. “NIHSS 38 (1 UN)”.
How do you score a comatose patient on the NIHSS?
If level of consciousness (1a) is 3 — the patient responds only with reflex motor or autonomic effects, or is totally unresponsive — the official NIHSS instructions set fixed scores for some items: sensory (8) is automatically 2, and best language (9) is automatically 3. Motor arm/leg items (5, 6) score 4 when there is no voluntary movement. The examiner still attempts every item. This calculator does not auto-fill coma scores; you enter each item manually, and the guidance above is shown in the item hints.
What is the difference between the NIHSS and the Glasgow Coma Scale (GCS)?
They measure different things. The GCS (Teasdale & Jennett, 1974) measures level of consciousness in three components — eye opening, verbal response, motor response — scored 3–15, and is used for any cause of impaired consciousness (trauma, coma, ICU). The NIHSS measures focal neurological deficits of stroke across 15 items scored 0–42: language, gaze, visual fields, limb strength, neglect, and more. A stroke patient can have a perfect GCS of 15 yet an NIHSS of 12 from aphasia and hemiplegia. Use our GCS calculator for consciousness assessment, and this NIHSS tool for stroke-deficit assessment.
What is the difference between the NIHSS and the modified Rankin Scale (mRS)?
The NIHSS is an impairment scale — it quantifies neurological deficits found on examination (0–42), usually measured at presentation and in the first days. The modified Rankin Scale is a disability/handicap scale — it grades functional independence in daily life (0 = no symptoms, 6 = dead), usually measured at 90 days as the outcome of stroke trials. Roughly: the NIHSS describes the stroke now; the mRS describes how the patient is doing later.
Does an NIHSS score of 0 rule out stroke?
No. A score of 0 means no measurable deficit on the 15 NIHSS items, but the scale under-detects posterior-circulation strokes (vertigo, ataxia, double vision, dysphagia), which often score 0–5. The NIHSS also has a left-hemisphere bias: language items contribute up to 7 of 42 points while neglect contributes only 2, so right-hemisphere strokes score lower for equal lesion volume. If stroke is clinically suspected, pursue imaging regardless of the NIHSS.
Who is allowed to perform the NIHSS, and is certification required?
The NIHSS is a clinical instrument for trained healthcare professionals — emergency physicians, neurologists, stroke-unit nurses, and paramedics in stroke systems of care. Reliability studies show it can be performed consistently by non-neurologists, but most hospitals and stroke trials require formal NIHSS certification (video-based training with test cases), typically renewed periodically. This calculator is an educational scoring aid; it does not certify anyone and does not replace bedside training.
What are the limitations of the NIHSS?
Key limitations: (1) poor capture of posterior-circulation signs — truncal ataxia, nystagmus, vertical gaze palsy, and bulbar signs are not scored; (2) left-hemisphere bias (language up to 7/42 points vs neglect 2/42); (3) weak inter-rater reliability on some items — limb ataxia and facial palsy have the lowest agreement; (4) it does not assess cognition, fatigue, mood, or many real-world disabilities; (5) scores vary between examiners, so the same patient scored by different people can differ by 2+ points. Score carefully, and treat the total as one data point among imaging and clinical judgment.
Someone may be having a stroke right now — what should I do?
Act immediately: use FAST — Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. In Indonesia call 119 (ambulance) or go to the nearest emergency department (IGD); note the exact time symptoms started, because clot-busting and clot-retrieval treatments are time-critical. Do not drive the person yourself if an ambulance is available, and do not give food, drink, or medication. This website is an educational screening aid — it is not medical advice, and no calculator replaces emergency care.
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