NIHSS Stroke Scale Calculator

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1a. Level of Consciousness (LOC) 0 - Alert 1 - Drowsy 2 - Stuporous 3 - Coma

1b. LOC Questions (month & age) 0 - Both correct 1 - One correct 2 - None correct

1c. LOC Commands (open/close eyes, grip) 0 - Both correct 1 - One correct 2 - None correct

2. Best Gaze 0 - Normal 1 - Partial gaze palsy 2 - Forced deviation

3. Visual Fields 0 - No visual loss 1 - Partial hemianopia 2 - Complete hemianopia 3 - Bilateral hemianopia

4. Facial Palsy 0 - Normal 1 - Minor 2 - Partial 3 - Complete

5. Motor Arm (best of left/right) 0 - No drift 1 - Drift 2 - Some effort against gravity 3 - No effort against gravity 4 - No movement

6. Motor Leg (best of left/right) 0 - No drift 1 - Drift 2 - Some effort against gravity 3 - No effort against gravity 4 - No movement

7. Limb Ataxia 0 - Absent 1 - One limb 2 - Two limbs

8. Sensory 0 - Normal 1 - Mild-moderate loss 2 - Severe-total loss

9. Best Language 0 - No aphasia 1 - Mild-moderate aphasia 2 - Severe aphasia 3 - Mute / global aphasia

10. Dysarthria 0 - Normal 1 - Mild-moderate 2 - Severe

11. Extinction / Inattention (Neglect) 0 - No abnormality 1 - One modality 2 - More than one modality

Results

NIHSS Total Score

0

out of 42

Severity Category	No stroke symptoms
Scale Range	0 (normal) to 42 (severe)

What is the NIH Stroke Scale (NIHSS)?

The National Institutes of Health Stroke Scale (NIHSS) is a standardized, 11-item clinical tool used worldwide to quantify the neurological impairment caused by an acute stroke. Each item assesses a specific function — consciousness, gaze, vision, facial and limb movement, sensation, language, speech, and attention. The scores are added together to give a single number from 0 (no deficit) to 42 (severe stroke). This calculator is a clinical education and documentation aid; it does not replace examination by a trained clinician.

The NIHSS comprises 11 items assessing consciousness, vision, motor, sensory and language function.

How to use this calculator

Examine the patient and select the appropriate score for each of the 11 items from the dropdown menus. Items with combined left/right testing (motor arm and motor leg) should reflect the standard NIHSS approach. Submit the form and the calculator sums every item to produce the total NIHSS score and a severity category.

The formula explained

The calculation is a straightforward addition: $$\text{NIHSS} = \text{1a} + \text{1b} + \text{1c} + \text{2} + \text{3} + \text{4} + \text{5} + \text{6} + \text{7} + \text{8} + \text{9} + \text{10} + \text{11}$$ There is no weighting — each item simply contributes its raw point value. Common severity bands are: 0 = no stroke symptoms, 1–4 = minor, 5–15 = moderate, 16–20 = moderate to severe, and 21–42 = severe stroke.

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The summed score ranges 0-42, mapped to severity categories from no stroke to severe.

Worked example

Suppose a patient scores: LOC 1, LOC questions 1, LOC commands 0, gaze 1, visual fields 1, facial palsy 2, motor arm 3, motor leg 2, ataxia 0, sensory 1, language 1, dysarthria 1, neglect 1. The total is $$1+1+0+1+1+2+3+2+0+1+1+1+1 = 15$$ placing the patient in the moderate stroke category.

FAQ

What is the maximum NIHSS score? The maximum is 42, reflecting a very severe stroke.

What score indicates a severe stroke? Scores of 21 and above are generally classified as severe.

Can this replace clinical judgment? No. The NIHSS supports assessment and communication but must be applied by appropriately trained healthcare professionals alongside imaging and clinical context.