NIHSS in Stroke Severity: Why and How? presentation.pptx

National Institute of Health Stroke Scale is used to assess the severity in ischemic stroke. it is very useful for stroke physicians for treatment and follow-up.

1. National Institutes of Health Stroke Scale (NIHSS): Why and How? Dr. Md. Saiduzzaman Munna Medical Officer Department of Neurology Mymensingh Medical College Hospital Mymensingh, Bangladesh.

2. Background It is a systematic assessment tool designed to measure the neurological deficits in acute ischemic stroke. First developed in 1989 as 15 item scale. Modified NIHSS consisting 5/8/11 domains have been developed.

3. Advantages of NIHSS Widely used, valid, reliable tool to assess stroke severity. Low inter-personal variability. Easy, less time consuming (even non-neurologists and nurses can perform). Few instruments needed (Only a pin to assess sensation). Well matches with arteries involved. Used to predict stroke outcome. Used to include or exclude patients from IV thrombolysis candidate.

4. Domains of NIHSS Level of consciousness: a) Responsiveness- 0- Alert, 1- Not alert but arousable by minor stimulation, 2- Not alert but requires repeated/strong painful stimulation for movement, 3- Respond only with reflex motor / autonomic effects or totally unresponsive.

5. Domains of NIHSS……… b) Questions: current month and age. 0- Answers both correctly 1- Answers one question correctly 2- Answers neither correctly. c) Commands: Ask to open and close eyes and grip and release nonparetic hand. 0- performs both correctly. 1- performs one task correctly. 2- performs neither task correctly.

6. Domains of NIHSS……… 2. Best Gaze: Test horizontal eye movement. 0- Normal. 1- Partial gaze palsy (Abnormal in one or both sides) 2- Forced deviation or total gaze paresis. 3. Visual: Visual field. 0- No visual loss. 1- Partial hemianopia. 2- Complete hemianopia. 3- Bitemporal hemianopia including cortical blindness.

7. Domains of NIHSS……… 4. Facial palsy: asked to show their teeth or raise their eyebrows and close their eyes. 0- Normal symmetrical movement. 1- Minor paralysis (asymmetry on smiling) 2- Partial paralysis (lower face). 3- Complete paralysis (both upper and lower face).

8. Domains of NIHSS……… 5. Motor arm: a) Motor arm left- Arm is extended (palms up) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before 10 seconds. 0- No drift. 1- Drifts before 10 seconds. 2- Some effort against gravity. 3- No effort against gravity. 4- No movement. b) Motor arm right- same as a.

9. Domains of NIHSS……… 6. Motor leg: Leg is raised at 30 degrees (supine). Drift is scored if the leg falls before 5 seconds. a) Motor leg left- 0- No drift. 1- Drifts within 5 seconds. 2. Some effort against gravity. 3- No effort against gravity. 4- No movement. b) Motor leg right- same as a.

10. Domains of NIHSS……… 7. Limb ataxia: Perform f inger-nose and heel-shin test. 0- Absent/Patient paralyzed/cannot understand or amputation or joint fusion. 1- present in one limb. 2- Present in both limbs. 8. Sensory: If level of consciousness is impaired, score if a grimace or an asymmetric withdrawal is observed. 0- No sensory loss. 1- Mild to moderate sensory loss. 2- Total sensory loss.

11. Domains of NIHSS……… 9. Best language: Have the patient describe a picture/ surrounding. 0- Normal. 1- Mild to moderate aphasia. 2- Severe aphasia. 3- Global aphasia.

12. Domains of NIHSS……… 10. Dysarthria: Patient is asked to read or repeat words from a list. 0- Normal or unable to test. 1- Mild to moderate dysarthria (Can be understood with some difficulty) 2- Severe dysarthria.

13. Domains of NIHSS……… 11. Extinction and inattention (Neglect) 0- No abnormality. 1- Inattention or extinction to one of the sensory modalities (Visual, tactile, auditory, spatial). 2- Profound hemi-inattention or extinction to more than one modality.

14. Interpretation NIHSS Score Severity < 5 Mild impairment 5-14 Moderate 15-25 Moderate to Severe > 25 Very Severe Range: 0-42

15. NIHSS in IV thrombolysis IV thrombolysis is indicated if NIHSS is between 4-22

16. Calculation Of NIHSS