Criteria

The National Institutes of Health stroke scale

A scoring system to measure severity of ischemic injury.

[ NIH Stroke Score Opens in new window ]

Performance on each of the following components of exam (carried out in the order listed) is scored:

  1. Level of Consciousness (LOC): LOC Scale; LOC questions; LOC commands

  2. Best gaze

  3. Visual: visual fields are tested

  4. Facial palsy

  5. Motor arm: arms are individually assessed for drift - each is scored separately

  6. Motor leg: legs are individually assessed for drift - each is scored separately

  7. Limb ataxia: presence in one or more limbs

  8. Sensory: evidence of sensory loss to pinprick

  9. Best language: assessment of aphasia using description of a picture

  10. Dysarthria: patient is asked to repeat words on a defined list

  11. Extinction and inattention: tests for inattention or extinction in 2 of the sensory modalities, vision and light touch.

Scores are totaled and a severity rating is given.

ABCD2 score[75][76]

Can be used to help predict the risk of stroke following TIA.

[ ABCD2 Score to Predict Stroke Risk after TIA Opens in new window ]

Risk factor points (maximum score 7 points)

  • Age ≥60 years: 1 point

  • BP ≥140 mmHg (systolic) or ≥90 mmHg (diastolic): 1 point

  • Clinical deficit of unilateral weakness: 2 points; or clinical deficit of speech impairment: 1 point

  • Duration ≥60 minutes: 2 points; or duration 10 to 59 minutes: 1 point

  • Diabetes: 1 point.

Risk categories

  • Low (0-3 points): 2-day stroke risk of 1%

  • Intermediate (4-5 points): 2-day stroke risk of 4.1%

  • High (6-7 points): 2-day stroke risk of 8.1%.

Refinements to the ABCD2 score, including the ABCD3 and ABCD3-I, have been validated and continue to be refined.[57][77] ABCD3 adds the presence of >2 TIAs in a week to the predictive model and ABCD3-I uses additional imaging data to improve prediction. There is some evidence to suggest that the ABCD3-I score is the most effective.[57][58] Evidence shows that risk prediction scores used in isolation are poor at discriminating low and high risk of stroke after TIA.[58]​[59]​​ This has led some national guidelines outside the US, e.g., the National Institute for Health and Care Excellence (NICE) in the UK, to recommend that all people with suspected TIA are considered as potentially high risk for stroke, with specialist assessment and investigation within 24 hours of symptom onset.[43]

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