What is the National Institutes of Health (NIH) stroke scale score for a patient with partial loss of sensation in one limb?

NIH Stroke Scale Score for Partial Loss of Sensation in One Limb

A patient with less sensitivity (partial loss of sensation) in one limb would receive a score of 1 on item 8 (sensory) of the NIH Stroke Scale. 1

Understanding the NIH Stroke Scale Sensory Assessment

The NIH Stroke Scale (NIHSS) is a standardized tool used to assess stroke severity, with scores ranging from 0 to 42, where higher scores indicate more severe strokes. Item 8 specifically evaluates sensory function using the following scoring criteria:

• Score 0: No sensory loss - normal sensation when tested with pinprick, or patient is alert and responsive with no evidence of sensory deficit 1
• Score 1: Mild to moderate unilateral sensory loss - patient feels pinprick is less sharp or is dulled on the affected side, or there is a loss of superficial pain with pinprick but the patient is aware of being touched 1
• Score 2: Severe sensory loss - patient is not aware of being touched in two or more extremities, or there is total loss of sensation in a specific distribution 1

Clinical Assessment Technique

The proper technique for sensory assessment involves:

• Using a safety pin or other sharp object to test sensation 1
• Testing both sides of the body, including face, arms, and legs 1
• Observing for grimace or withdrawal if the patient is stuporous 1
• Comparing sensation between affected and unaffected sides 1

Clinical Significance and Implications

• Sensory deficits are common manifestations of stroke, with studies showing that approximately 47% of stroke patients have impaired touch discrimination in the contralesional hand 2
• Sensory impairment contributes to the overall NIHSS score, with higher scores correlating with poorer outcomes 1
• Somatosensory impairment after stroke is common, with studies showing that 7-53% of patients have impaired tactile sensations 3
• Sensory deficits can significantly impact functional recovery and rehabilitation potential 1

Common Pitfalls in Assessment

• Ensure that you are testing both sides of the body for comparison 1
• Be careful not to confuse decreased sensation with complete absence of sensation 1
• Remember that some patients may have sensory impairment in the ipsilesional ("unaffected") hand as well, which occurs in approximately 16% of stroke patients 2
• Different somatosensory modalities (touch, proprioception, stereognosis) should be assessed independently as they may be affected differently 3

Importance in Stroke Management

• The NIHSS score helps quantify the degree of neurological deficit and facilitates communication between healthcare professionals 1
• The score helps identify the possible location of vessel occlusion and provides early prognosis 1
• The assessment assists in identifying patient eligibility for various interventions and the potential for complications 1