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NIH Stroke Scale (NIHSS) calculator

The National Institutes of Health Stroke Scale scores the neurological deficit of a stroke across 15 items: consciousness, gaze, vision, facial palsy, arm and leg strength on each side, ataxia, sensation, language, speech and inattention. The total runs from 0 to 42, and higher means a more severe deficit. Brott and colleagues published it in 1989. This calculator is written for clinicians and is not a diagnosis.

Last reviewed: By the uncovermyrisk.com editorial team Educational only, not medical advice.

Chest pain, trouble breathing or confusion: call 911 now.General safety advice (not part of the published scale). Sudden face drooping, arm weakness, trouble speaking, loss of balance or vision changes are emergency signs of stroke: call 911 (CDC). Do not delay emergency care to complete a score.

Score each item

Choose one answer for every item. "UN" is offered only where the scale allows it. Nothing you enter leaves this page.

1a. Level of consciousness
1b. Level of consciousness questions (month, age)
1c. Level of consciousness commands (close eyes, grip hand)
2. Best gaze
3. Visual fields
4. Facial palsy
5a. Motor arm, left (10 seconds)
5b. Motor arm, right (10 seconds)
6a. Motor leg, left (5 seconds)
6b. Motor leg, right (5 seconds)
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction and inattention (formerly neglect)
Result appears here

What you will see

The total from 0 to 42, the items that scored points, any items marked UN and the severity group used in stroke studies.

Educational only, not medical advice. Not a diagnosis. An abnormal score does not prove or rule out a stroke.

Source

Brott T et al., Stroke 1989, the original scale. Items, answers and points are taken from Table 2 of an open-access (CC BY 4.0) review, Budinčević H et al., Medicina (Kaunas) 2022. Severity groups are as defined in two open-access (CC BY 4.0) cohort studies, Mohamed Anees S et al., J Clin Med 2026 and Shrestha P et al., Cureus 2026. The tests check every item range, the 0 and 42 limits, UN handling and the group cut points.

Validated in

Developed to measure the severity of acute cerebral infarction (Brott 1989). The review describes it as the broadly adopted stroke impairment and severity scale in hospital settings, valid and reliable for clinical and research use, and reliable over telemedicine. The groups shown here were used for adults with acute ischemic stroke in cohorts from Malaysia and Nepal.

Limits

The scale does not test the cranial nerves in detail, underestimates brainstem and cerebellar strokes, can miss small deficits, does not reflect each hemisphere equally and is least reliable in people with cognitive problems. Some real changes on repeat examination do not change the score. An abnormal score does not support or refute a diagnosis of stroke (Budinčević 2022). Official training and the full item instructions come from the NIH.

NIH Stroke Scale items and points

Score every item and add the points. The total runs from 0 to 42 (Budinčević 2022).

ItemAnswers and points
1a. Level of consciousness0 = Alert; responsive; 1 = Not alert; somnolent; 2 = Not alert; soporose; 3 = Comatose
1b. Level of consciousness questions (month, age)0 = Both answers correct; 1 = One answer correct; 2 = Neither answer correct
1c. Level of consciousness commands (close eyes, grip hand)0 = Performs both tasks correctly; 1 = Performs one task correctly; 2 = Performs neither task correctly
2. Best gaze0 = Normal; 1 = Partial gaze palsy; 2 = Total gaze palsy
3. Visual fields0 = No visual loss; 1 = Partial hemianopia; 2 = Complete hemianopia; 3 = Bilateral hemianopia (blind, including cortical blindness)
4. Facial palsy0 = Normal; 1 = Minor paralysis; 2 = Partial paralysis; 3 = Complete paralysis
5a. Motor arm, left (10 seconds)0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort against gravity, limb falls; 4 = No movement; UN = Amputation or joint fusion
5b. Motor arm, right (10 seconds)0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort against gravity, limb falls; 4 = No movement; UN = Amputation or joint fusion
6a. Motor leg, left (5 seconds)0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort against gravity, limb falls; 4 = No movement; UN = Amputation or joint fusion
6b. Motor leg, right (5 seconds)0 = No drift; 1 = Drift; 2 = Some effort against gravity; 3 = No effort against gravity, limb falls; 4 = No movement; UN = Amputation or joint fusion
7. Limb ataxia0 = Absent; 1 = Present in one limb; 2 = Present in two limbs; UN = Amputation or joint fusion
8. Sensory0 = Normal; 1 = Mild to moderate sensory loss; 2 = Severe to total sensory loss
9. Best language0 = No aphasia; 1 = Mild to moderate aphasia; 2 = Severe aphasia; 3 = Mute, global aphasia
10. Dysarthria0 = Normal; 1 = Mild to moderate dysarthria; 2 = Severe dysarthria; UN = Intubated or other physical barrier
11. Extinction and inattention (formerly neglect)0 = No abnormality; 1 = Mild; 2 = Severe

Source: Table 2 of Budinčević et al., 2022 (Budinčević 2022), after Brott et al., 1989 (Brott 1989). Arm and leg items are scored for the left and right side separately.

Items marked UN

The table allows "UN" for the arm, leg and ataxia items when there is an amputation or joint fusion, and for dysarthria when the patient is intubated or has another physical barrier (Budinčević 2022). This calculator adds no points for a UN item and lists it with the result, so the total covers only the items that could be scored. Record the reason next to the score.

Severity groups

Studies group the total in slightly different ways. A Malaysian cohort of adults with acute ischemic stroke used minor (1 to 4), moderate (5 to 15), moderate to severe (16 to 20) and severe (21 to 42) (Mohamed Anees 2026). A study from Nepal used the same cut points but counted 0 to 4 as minor (Shrestha 2026). This calculator shows a total of 0 as no measurable deficit on the scale. The review notes that a score under 4 in the first 48 hours has been linked with a good outcome (Budinčević 2022).

Limits

The NIHSS does not test the cranial nerves in detail, it underestimates the severity of brainstem and cerebellar strokes, it can miss some discrete deficits, it does not reflect each hemisphere equally and it is least reliable in patients with cognitive dysfunction. Some clinical changes on repeated examination are not shown as changes in the score, and an abnormal score does not support or refute a stroke diagnosis (Budinčević 2022). Shorter versions exist for emergency medical services, such as the modified NIHSS (0 to 31) and the shortened NIHSS for EMS (0 to 29) (Budinčević 2022). This page does not replace NIH training and certification in the scale.

Related tools

For level of consciousness in more detail, see the Glasgow Coma Scale calculator. After a transient ischemic attack, see the ABCD2 score. For long-term stroke risk factors, see the stroke risk factor check, and for atrial fibrillation, CHA2DS2-VASc explained.

Sources

  1. Budinčević H, Meštrović A, Demarin V. Stroke Scales as Assessment Tools in Emergency Settings: A Narrative Review. Medicina (Kaunas). 2022;58(11):1541. doi:10.3390/medicina58111541. PMID 36363498. Open access (CC BY 4.0). Table 2 (the National Institutes of Health Stroke Scale, 0 to 42) and the section on scales used in hospital settings. pmc.ncbi.nlm.nih.gov/articles/PMC9696547/
  2. Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870. doi:10.1161/01.str.20.7.864. PMID 2749846. Original NIH Stroke Scale paper (scale taken from the open-access review above). doi.org/10.1161/01.str.20.7.864
  3. Mohamed Anees S, Cheong XK, Tan HJ, et al. The Prevalence, Predictors, and In-Hospital Outcomes of Stroke-Associated Infection in Acute Ischemic Stroke: A Malaysian Prospective Cohort Study. J Clin Med. 2026;15(13):4898. doi:10.3390/jcm15134898. PMID 42452360. Open access (CC BY 4.0). Methods (NIHSS severity groups). pmc.ncbi.nlm.nih.gov/articles/PMC13361296/
  4. Shrestha P, Shrestha MS, Mahaseth A, et al. Association Between an Incomplete Circle of Willis and Acute Ischemic Stroke Severity at Admission: A Computed Tomography Angiography Study From Nepal. Cureus. 2026;18(9):e116843. doi:10.7759/cureus.116843. PMID 42927105. Open access (CC BY 4.0). Methods (NIHSS severity groups). pmc.ncbi.nlm.nih.gov/articles/PMC13695388/
  5. Centers for Disease Control and Prevention. Signs and Symptoms of Stroke. www.cdc.gov/stroke/signs-symptoms/index.html

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.