A modification of the NIH Stroke Score (NIHSS) can be used to evaluate pediatric patients who have recently had a stroke.
The PedNIHSS includes language testing items:
(1) Repetition: Stop; Stop and go; if it rains we play inside; the President lives in Washington
(2) Reading: Stop; See the dog run; Little children like to play outdoors.
(3) Naming of items in a picture: clock, pencil, skateboard, shirt, baseball, bicycle
(4) Fluency and word findings: asking the child to give a story to match a picture
|
Parameter |
Finding |
Points |
|
level of consciousness (1A) |
alert |
0 |
|
|
not alert but arousable by minor stimulation |
1 |
|
|
not alert, obtunded, requires repeated or painful stimuli |
2 |
|
|
unresponsive or responds only with reflex motor or autonomic effects |
3 |
|
questions (1B) |
answers both correctly |
0 |
|
|
answers one question correctly |
1 |
|
|
answers neither question correctly |
2 |
|
commands (1C) |
performs both tasks correctly |
0 |
|
|
performs one task correctly |
1 |
|
|
performs neither task correctly |
2 |
|
best gaze (2) |
normal |
0 |
|
|
partial gaze palsy |
1 |
|
|
total gaze palsy or forced deviation |
2 |
|
visual fields (3) |
no visual loss |
0 |
|
|
partial hemianopsia |
1 |
|
|
complete hemianopsia |
2 |
|
|
bilateral hemianopsia |
3 |
|
facial palsy (4) |
normal |
0 |
|
|
minor paralysis |
1 |
|
|
partial paralysis |
2 |
|
|
complete paralysis |
3 |
|
motor, left arm (5) |
no drift |
0 |
|
|
drift before 10 seconds |
1 |
|
|
falls before 10 seconds |
2 |
|
|
no effort against gravity |
3 |
|
|
no movement |
4 |
|
motor, right arm (5) |
no drift |
0 |
|
|
drift before 10 seconds |
1 |
|
|
falls before 10 seconds |
2 |
|
|
no effort against gravity |
3 |
|
|
no movement |
4 |
|
motor, left leg (6) |
no drift |
0 |
|
|
drift before 5 seconds |
1 |
|
|
falls before 5 seconds |
2 |
|
|
no effort against gravity |
3 |
|
|
no movement |
4 |
|
motor, right leg (6) |
no drift |
0 |
|
|
drift before 5 seconds |
1 |
|
|
falls before 5 seconds |
2 |
|
|
no effort against gravity |
3 |
|
|
no movement |
4 |
|
limb ataxia (7) |
absent |
0 |
|
|
one limb |
1 |
|
|
two limbs |
2 |
|
sensory (8) |
normal |
0 |
|
|
mild loss |
1 |
|
|
severe loss |
2 |
|
best language (9) |
normal |
0 |
|
|
mild aphasia |
1 |
|
|
severe aphasia |
2 |
|
|
mute or global aphasia |
3 |
|
dysarthria (10) |
normal |
0 |
|
|
mild |
1 |
|
|
severe |
2 |
|
extinction/inattention (11) |
normal |
0 |
|
|
mild |
1 |
|
|
severe |
2 |
modified NIH stroke scale =
= SUM(points for all 15 parameters)
Interpretation:
• minimal score: 0
• maximum score: 42 if all items scored. If only limbs contralateral to the stroke are scored the maximum is 34.
• The lower the score, the better the patient status.
Specialty: Neurology, Pedatrics
