1a — Level of Consciousness

0 — Alert, keenly responsive+01 — Arousable to minor stimulation; obeys/answers not fully+12 — Not alert; requires repeated stimulation or strong to respond+23 — Unresponsive/reflex posturing/flaccid (score 3)+3

1b — LOC Questions (Ask month + patient's age — score worst correct answer)

0 — Both answers correct+01 — Only one correct (or intubated/dysarthric/aphasia)+12 — Neither correct or no response+2

1c — LOC Commands (Open and close eyes; grip and release non-paretic hand)

0 — Obeys both correctly+01 — Obeys one correctly+12 — Neither obeys+2

2 — Best Gaze (Horizontal eye movements only; do NOT test VOR)

0 — Normal gaze symmetry and velocity+01 — Partial gaze palsy; gaze abnormal but can be overcome+12 — Forced deviation or total gaze paresis; not overcome by VOR+2

3 — Visual Fields (Confrontation all 4 quadrants; finger counts or visual threat)

0 — No visual loss+01 — Partial hemianopia (quadrantanopia)+12 — Complete hemianopia (dense)+23 — Bilateral visual loss/blindness (no light perception bilaterally)+3

4 — Facial Palsy (Ask to show teeth, raise eyebrows, close eyes tightly)

0 — Normal symmetric movements+01 — Minor paralysis (flattened NLF, smile asymmetry)+12 — Partial paralysis (total or near-total lower face paralysis)+23 — Complete paralysis (absent movement in upper and lower face)+3

5 — Motor Arm (Extend arm 90° if sitting, 45° if supine for 10 seconds; test WORSE arm)

0 — No drift; holds position for 10 seconds+01 — Drift but doesn't fall until 10 seconds; no table contact+12 — Some effort against gravity; drift, hits bed within 10 seconds+23 — No effort against gravity; arm falls to bed immediately+34 — No movement; flaccid+4

6 — Motor Leg (Supine, raise leg 30° for 5 seconds; test WORSE leg)

0 — No drift; holds for 5 seconds+01 — Drift; leg falls before 5 seconds but not to bed+12 — Effort against gravity but falls to bed within 5 seconds+23 — No effort against gravity; falls to bed immediately+34 — No movement; flaccid+4

7 — Limb Ataxia (Finger-nose-finger and heel-shin — score only if clearly out of proportion to weakness)

0 — Absent or not testable (paralyzed/amputee)+01 — Ataxia in one limb+12 — Ataxia in two limbs+2

8 — Sensory (Pinprick face, arm, trunk, leg bilaterally; score only stroke-related loss)

0 — Normal; no sensory loss+01 — Mild-moderate loss; patient feels touch but less sharp on affected side+12 — Severe to total; patient unaware of being touched on one side+2

9 — Best Language (Name objects on card; describe scene picture; read sentences)

0 — No aphasia; normal+01 — Mild-moderate aphasia; labored speech or comprehension reduced+12 — Severe aphasia; fragmentary expression; cannot identify most items+23 — Mute; global aphasia; no usable speech or auditory comprehension+3

10 — Dysarthria (Read aloud: 'mama', 'tip-top', 'fifty-fifty')

0 — Normal articulation+01 — Mild-moderate dysarthria; slurred but understandable+12 — Severe; speech so slurred it's unintelligible in absence of dysphasia (intubated = UN)+2

11 — Extinction/Inattention (Double simultaneous stimulation; visual, tactile, auditory, spatial, personal neglect)

0 — No abnormality+01 — Visual/tactile/auditory/spatial/personal inattention on one side+12 — Profound hemi-inattention to more than one modality; does not recognize own hand or orients only to one side+2

Modified NIHSS — Neurological Severity in Acute Ischemic Stroke

Modified NIHSS — Neurological Severity in Acute Ischemic Stroke