2. NIH Stroke Scale The Good, The Bad, and The Ugly Press F5 for sound on the presentation

3. NIHSS Level of consciousness Alert 0 points Alert 0 points Drowsy 1 point Drowsy 1 point Stupor 2 points Stupor 2 points Coma 3 points Coma 3 points

4. NIHSS Questions Month/Age Answer both correctly 0 points Answer both correctly 0 points Answers one correctly1 point Answers one correctly1 point None are correct2 points None are correct2 points

5. NIHSS Response to 2 Commands Follows 2 command correctly0 points Follows 2 command correctly0 points Follows 1 command correctly1 point Follows 1 command correctly1 point Cannot follow either command2 points Cannot follow either command2 points

6. NIHSS Best Gaze Normal0 points Normal0 points Partial gaze to one side1 point Partial gaze to one side1 point Forced gaze to one side2 points Forced gaze to one side2 points

7. NIHSS Visual Fields No visual loss0 points No visual loss0 points Partial hemianopsia1 point Partial hemianopsia1 point Complete hemianopsia 2 points Complete hemianopsia 2 points Bilateral visual loss3 points Bilateral visual loss3 points

8. NIHSS Facial Motor Function No weakness 0 points No weakness 0 points Minor unilateral weakness 1 point Minor unilateral weakness 1 point Partial unilateral weakness 2 points Partial unilateral weakness 2 points Complete uni or bilateral weakness 3 points Complete uni or bilateral weakness 3 points

9. NIHSS Upper Extremity Motor Function (Right and Left Scored Independently) Normal0 points Normal0 points Drift1 point Drift1 point Some effort against gravity2 points Some effort against gravity2 points No effort against gravity3 points No effort against gravity3 points No movement4 points No movement4 points

10. NIHSS Lower Extremity Motor Function ( Right and Left Scored Independently) Normal0 points Normal0 points Drift1 point Drift1 point Some effort against gravity2 points Some effort against gravity2 points No effort against gravity3 points No effort against gravity3 points No movement4 points No movement4 points

11. NIHSS Extremity Ataxia (Cannot Be Tested in Presence of Paresis) No ataxia0 points No ataxia0 points Ataxia in 1 extremity1 point Ataxia in 1 extremity1 point Ataxia in 2 extremities2 points Ataxia in 2 extremities2 points

12. NIHSS Sensory Loss Normal0 points Normal0 points Mild to moderate loss1 point Mild to moderate loss1 point Severe to total loss2 points Severe to total loss2 points

13. NIHSS Language No aphasia0 points No aphasia0 points Mild to moderate aphasia1 point Mild to moderate aphasia1 point Severe aphasia2 points Severe aphasia2 points Mute3 points Mute3 points

14. NIHSS Articulation (Dysarthia) Normal0 points Normal0 points Mild to moderate1 point Mild to moderate1 point Severe2 points Severe2 points

15. NIHSS Extinction/Inattention No abnormality0 points No abnormality0 points Extinction to one modality1 point Extinction to one modality1 point Extinction to 2 modalities2 points Extinction to 2 modalities2 points

16. The Good Reliable Reliable – Interrater reliability confirmed Valid Valid Time efficient Time efficient – Original trial had a 6 minute average – Cell phone with video capability takes 38 seconds longer than bedside examination

17. The Bad Tendency to favor speech/language function over higher integrated sensory function Tendency to favor speech/language function over higher integrated sensory function – L MCA infarcts average 4 points higher than R MCA infarcts Some items represent redundancy Some items represent redundancy – Ataxia with gross motor function – Dysarthria with aphasia Too often ataxia is over represented Too often ataxia is over represented

18. The Ugly Brainstem/cerebellar function overly minimized Brainstem/cerebellar function overly minimized Not a good scale for the “dizzy plus” patient Not a good scale for the “dizzy plus” patient