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Levels Of Stroke Damage

Levels of Stroke Damage

Stroke survivors and their loved ones understand that a stroke has devastating physical and neurological effects. Every stroke is different, and there is no way to predict stroke severity until examination by specialized healthcare professionals. Physicians measure the initial damage of a stroke by using the NIH Stroke Scale or NIHSS.


The NIHSS measures the level of brain damage from a stroke along with physical and cognitive impairment. Brain functions including consciousness, vision, sensation, movement, speech, and language are measured when evaluating stroke severity. The larger the NIH stroke score, the more devastating the damage to brain functions.



  • 0: no stroke
  • 1-4: minor stroke
  • 5-15: moderate stroke
  • 15-20: moderate to severe stroke
  • 21-42: severe stroke

The NIHSS test may be administered similarly to this:


During this test, a physician will asses the following and assign points appropriately:

  1. Consciousness: Tested by asking the patient a simple question (month and day) and assessing their ability to follow a  simple command (closing eyes and squeezing hand)
  2. Gaze: Tests patients capability of moving their eyes normally by following an object with their gaze
  3. Visual Field: Examines how much a patient can see outside of what is directly in front of them
  4. Facial Palsy: Verifies if a patient can adequately move their facial muscles
  5. Motor Arm: Tests if a patient can hold their arm out for 10 seconds without drift
  6. Motor Leg: Tests if a patient can hold their leg up for 5 seconds without drift
  7. Limb Ataxia: Tests for motor damage in the cerebellum by having the patient touch their fingers to their nose and their heels to their shins on both sides
  8. Sensory: Assess response to sensory stimuli such as a pinprick
  9. Language: Patient is asked to describe the situation taking place in a picture to test their language capabilities
  10. Dysarthria: Evaluates amount of speech slurring in the patient
  11. Extinction and inattention: Assess the amount of attention the patient gives to their five senses and their environment


Scores on the NIHSS can be a tool for predicting patient outcome. Generally speaking, the lower the score, the greater the probability of full recovery while the higher the score, the greater the probability of patient death.

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