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Discussion

Ataxia vs weakness

Can someone please help me to understand scoring for ataxia using the NIHSS? If a person has limb drift in both arm and leg unilaterally, how do you determine whether the "clumsiness" is "out of proportion" to the weakness when doing the finger-nose-finger and heel-shin portions of the scale? Also, it says to score 1 if ataxia is present in 1 limb and 2 if it is present it 2 limbs. What if there appears to be ataxia in both arms and both legs? Or 3/4 limbs? Or is it a 1 if there is only ataxia present in 1 or both arms OR 1 or both legs?

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    Has the patient had an acute stroke? If so, then you should only be testing the side affected by this stroke. That's why for ataxia, it only gives you the option of 0 (no ataxia) 1 (ataxia in upper or lower limb) or 2 (ataxia in both limbs). Deciding if it's ataxia or just weakness can be a judgement call, but also comes to some degree with experience of stroke and it's classification according to Bamford http://www.medquarterly.com/mq88/MQPDF/MM/OxfordStrokeClassification.pdf

    If you're not assessing a stroke patient then don't use the NIHSS. ;)

    Edit- are you NIHSS certified?

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