PedNIHSS

1. Level of consciousness.

It should always be scored, even if there are obstacles to the examination such as endotracheal tube, language barriers or others. The score “3” is only considered if the patient does not make movements (other than reflex responses) in response to painful stimuli.

Children under 2 years old: a family member must be present 1st Question: how old are you? (correct if he indicates it verbally or with his fingers) 2nd Question: where is XX?, XX being the family member who accompanies him (correct if he says it, points at it with his hand, or looks at it). Intubated, etc. or severe dysarthria, score 1. If aphasic or stuporous (does not understand), score 2.

The child is asked to open and close his eyes and point to his nose. Substitute another order if you cannot use your hands for any reason. It is considered appropriate if the unequivocal intention to respond to the command is made even if it is not completed due to motor weakness. If the patient does not respond to the command, show him or her with mime what we ask him to do and write down the result. Only the initial response is considered.

Only assess horizontal gaze voluntarily or with oculocephalic reflexes. If the patient has averted gaze but this is corrected voluntarily, with eye contact or in a reflex manner, score 1. If he or she has peripheral paresis of an oculomotor nerve (III, IV or VI), score 1.

The visual fields (upper and lower quadrants) are explored by confrontation, using finger counting (children over 6 years) or threat reflex (children 4 months-6 years). The patient should be encouraged, but if he or she is observed looking at the place where the fingers are moving, this is scored as a normal response. If there is unilateral blindness or enucleation, the visual fields in the preserved eye are evaluated. Score “1” only if clear asymmetry, including quadrantanopsia. If the patient is blind for any reason, score “3”. Perform double simultaneous stimulation to detect possible visual extinction. If extinction is demonstrated, it is scored “1” and these results are also used in question 11.

Ask (using mime if necessary) that the child show his teeth, raise his eyebrows, and close his eyes. Score the symmetry of the grimace in response to painful stimuli in patients who do not respond or do not understand the command. If facial trauma, bandages, orthotracheal tube or other physical barriers, try to remove them where possible to facilitate the evaluation of this section.

5. Motor function of the arms (Upper extremity paresis)

The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Claudication is scored if the arm falls within 10 seconds. For children too immature to follow precise instructions or uncooperative for any reason, scoring is based on observation of spontaneous or elicited movement according to the same classification scheme, without regard to temporal criteria. In the aphasic patient, the response is encouraged by using urgency in the explorer's voice and pantomime, but not painful stimulation. Examine each arm separately, starting with the non-paretic arm. Only in the case of amputation or joint fusion or immobilization, a "9" can be scored and the examiner must clearly write the explanation to score as a "9".

6. Motor function of the legs (Lower extremities paresis)

The limb is placed in the appropriate position: extend the leg 30º in a supine position. Claudication is scored if the leg falls within 5 seconds. For children who are too immature to follow precise instructions or are uncooperative for any reason, scoring is based on observation of spontaneous or elicited movement according to the same classification scheme, without regard to temporal criteria. In the aphasic patient, the response is encouraged by using urgency in the explorer's voice and pantomime, but not painful stimulation. Examine each leg separately, starting with the non-paretic leg. Only in the case of amputation or joint fusion or immobilization, a "9" can be scored and the examiner must clearly write the explanation to score as a "9".

This section explores the existence of a cerebellar lesion. It is evaluated with eyes open, using the “finger-nose-finger” and “heel-knee” maneuvers on both sides. Ataxia is scored only if it is present and disproportionate to the degree of paresis. In children under 5 years old, it can be replaced by the task of reaching for a toy for the upper limb and kicking a toy that the explorer is holding in his or her hand. Patients who do not understand or present paresis are scored “0”.

Sensation or grimace when pricked or withdrawal when faced with painful stimuli in patients with aphasia or stuporous patients. In children too young or uncooperative to grade loss of sensation, observe any response to the prick and score it according to the scoring scheme as a normal, diminished, or severely diminished response. Only loss of sensation attributable to the stroke is scored as abnormal and the evaluator must examine as many areas of the body (arms (not hands), legs, trunk and face) as necessary to adequately check for loss of sensation. A score of “2” is given only when severe or complete loss of sensation can be clearly demonstrated. Aphasic or stuporous patients score “1” or “0”.

You will assess the understanding shown in all the previous tests. For children over 6 years old with normal prior language development; You are asked to describe what happens or the name of various objects shown, repeating words from a list. If vision loss interferes with testing, ask the patient to identify objects placed in the hand, repeat, and produce speech. Intubated patients are asked to write. The comatose patient (questions 1a = 3) arbitrarily scores “3” at this point. The examiner should choose a score in the patient with stupor or limited cooperation, but only score “3” if the patient is mute and does not obey simple commands. For children ages 2 to 6, scoring will be based on observations of speech and language comprehension during the screening.

Ask patients to read or repeat the words on the attached list. If the patient has severe aphasia, the clarity of spontaneous speech articulation can be evaluated. Only if the patient is intubated or has another type of physical barrier to speech production is it scored "9," and the examiner must clearly write an explanation.

It is assessed by the patient's reaction to a simultaneous and symmetrical bilateral painful stimulus (extinction), and by their reactions to visual, tactile, auditory, spatial or personal stimuli, in the previous tests (negligence).