This is fundamental and important for users to keep in mind. The point of the NIHSS is to rate groups of patients, not individuals. What pearls, pitfalls and/or tips do you have for users of the NIH stroke scale? Are there cases in which it has been applied, interpreted, or used inappropriately? The NIH stroke scale was developed for use in the NINDS tPA trial. Why did you develop the NIH stroke scale? The patient with even a large territory posterior circulation stroke syndrome may still have a low or normal NIHSS, highlighting one of its important limitations.A simpler, modified version of the NIHSS has been found to have greater interrater reliability with equivalent clinical performance, although it has not been as widely adopted as the original NIHSS.

facial movement, limb ataxia, neglect, level of consciousness, and dysarthria), and some may be quite limited due to altered mental status, for example.

Some components of the NIHSS have lower interrater reliability (i.e.

These patients, however, are also the most severely debilitated and dependent from their strokes as well.

Many guidelines and protocols warn that administering tPA in patients with a high NIHSS score (>22) is associated with increased risk of hemorrhagic conversion.

Patients with a total score of 4 or less generally have favorable clinical outcomes and have a high likelihood of functional independence regardless of treatment.NIHSS scores when assessed within the first 48 hours following a stroke have been shown to correlate with clinical outcomes at the 3-month and 1-year mark.Increasing scores indicate a more severe stroke and has been shown to correlate with the size of the infarction on both CT and MRI evaluation.The National Institutes of Health Stroke Scale (NIHSS) was developed to help physicians objectively rate severity of ischemic strokes.

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