NIH Stroke Scale Score for Sensory Exam with Complete Unilateral Loss
For a patient unable to feel pin prick at all on one side, the correct NIH Stroke Scale score for item 8 (Sensory) is 2, indicating severe or total sensory loss.
Understanding the NIH Stroke Scale Sensory Assessment (Item 8)
The NIH Stroke Scale (NIHSS) is a standardized stroke severity assessment tool with scores ranging from 0 to 42, where higher scores indicate more severe strokes. The sensory component (item 8) specifically evaluates sensory function using the following scoring criteria:
- 0 = Normal; no sensory loss 1
- 1 = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side 1
- 2 = Severe or total sensory loss; patient is not aware of being touched on the affected side 1
Clinical Assessment Technique
The proper technique for assessing sensory function in the NIHSS involves:
- Testing pinprick sensation on both sides of the body (face, arms, trunk, and legs) 1
- Comparing the sensation between the affected and unaffected sides 1
- When a patient is completely unable to feel pinprick on one side of the body, this represents a severe sensory deficit warranting a score of 2 1
Clinical Significance and Implications
- Sensory deficits are common manifestations of stroke and contribute to the overall NIHSS score 1
- Complete unilateral sensory loss (score of 2) indicates significant damage to sensory pathways 1
- Higher NIHSS scores correlate with poorer outcomes and greater functional disability 1
Common Pitfalls in Assessment
- Do not confuse decreased attention or consciousness with sensory loss 2
- Ensure proper testing of all body areas (face, arm, trunk, leg) before assigning a score 1
- Distinguish between partial sensory loss (score of 1) and complete sensory loss (score of 2) 1
- Be aware that patients with severe aphasia may have difficulty communicating sensory perception, requiring careful assessment of non-verbal cues 2
Importance in Stroke Evaluation
- Sensory deficits contribute to the overall assessment of stroke severity and localization 1
- Complete unilateral sensory loss typically indicates a contralateral lesion in the sensory pathways, often in the thalamus or sensory cortex 1
- The presence of severe sensory loss may impact rehabilitation strategies and functional recovery 1