Spanish - NIHSSBelow are prompts translated from English to Spanish to provide to your patient. Follow the prompts, playing the accompanying audio before proceeding through the exam.
E: Hello, my name is ___ . What is your name?
S: Hola, mi nombre es ___ . ¿Cómo se llama?
E: We are worried that you might have a stroke. We are here to examine you.
S: Nos preocupa que pueda tener un derrame cerebral. Estamos aquí para examinarle.
E: I will be playing Spanish recordings from my phone. Please answer the questions or follow the instructions.
S: Estaré reproduciendo grabaciones español desde mi teléfono. Por favor, responda a las preguntas o siga los comandos.
E: Hello! Hello! Can you hear me?
S: ¡Hola! ¡Hola! ¿Puede escucharme?
The patient is asked the month and his/her age. The answer must be correct — there is no partial credit for being close. Aphasic and stuporous patients who do not comprehend the questions will score 2. Patients unable to speak because of endotracheal intubation, orotracheal trauma, severe dysarthria from any cause, language barrier, or any other problem not secondary to aphasia are given a 1. It is important that only the initial answer be graded and that the examiner not “help” the patient with verbal or non-verbal cues.
E: What month is it? How old are you?
S: ¿En que mes estamos? ¿Cuántos años tiene?
The patient is asked to open and close the eyes and then to grip and release the nonparetic hand. Substitute another one-step command if the hands cannot be used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If the patient does not respond to command, the task should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none, one, or two commands). Patients with trauma, amputation, or other physical impediments should be given suitable one-step commands. Only the first attempt is scored.
E: Close your eyes tightly. Now open your eyes. Make a fist with your hand. Now open your hand.
S: Cierre los ojos con fuerza. Ahora abra los ojos. Muestreme su puño. Ahora abra su mano.
Only horizontal eye movements will be tested. Voluntary or reflexive (oculocephalic) eye movements will be scored, but caloric testing is not done. If the patient has a conjugate deviation of the eyes that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI), score a 1. Gaze is testable in all aphasic patients. Patients with ocular trauma, bandages, preexisting blindness, or other disorder of visual acuity or fields should be tested with reflexive movements, and a choice made by the investigator. Establishing eye contact and then moving More the patient from side to side will occasionally clarify the presence of a partial gaze palsy.
E: Follow my finger with your eyes. Keep your head still.
S: Siga mi dedo con sus ojos. Manténga la cabeza quieta.
E: Keep your head still.
S: Manténga la cabeza quieta.
Visual fields (upper and lower quadrants) are tested by confrontation, using finger counting or visual threat, as appropriate. Patients may be encouraged, but if they look at the side of the moving fingers appropriately, this can be scored as normal. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. If patient is blind from any cause, score 3. Double simultaneous stimulation is performed at this point. If there is extinction, patient receives a 1, and the results are used to respond to item 11.
E: Look at my nose. Point to the side I am wiggling. Which side? Which side? Which side?
S: Mire mi nariz. Señale que mano estoy moviendo. ¿De qué lado? ¿De qué lado? ¿De qué lado?
E: Look at my nose. Am I wiggling my fingers on the right, left, or both sides? Which side? Which side?
S: Mire mi nariz. ¿Estoy moviendo mis dedos hacia la derecha, la izquierda, o ambos lados?¿De qué lado?¿De qué lado?
E: Keep looking at my nose.
S: Siga mirando mi nariz.
Ask — or use pantomime to encourage — the patient to show teeth or raise eyebrows and close eyes. Score symmetry of grimace in response to noxious stimuli in the poorly responsive or non-comprehending patient. If facial trauma/ bandages, orotracheal tube, tape, or other physical barriers obscure the face, these should be removed to the extent possible.
E: Show me your teeth. Raise your eyebrows. Close your eyes. Now open your eyes.
S: Muéstreme sus dientes. Levante las cejas. Cierre los ojos. Ahora abra los ojos.
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before 10 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice.
E: Raise your left arm and keep it straight. Hold it up for 10 seconds.
S: Levante el brazo izquierdo y mantengalo recto. Sostengalo durante diez segundos.
E: Raise your arms and keep them straight. Hold them up for 10 seconds.
S: Levante los brazos y mantengalos rectos. Sostenlos durante diez segundos.
E: Keep it up! Up! Up!
S: ¡Mantengalos levantados! ¡Hacia arriba! ¡Hacia arriba!
The limb is placed in the appropriate position: extend the arms (palms down) 90 degrees (if sitting) or 45 degrees (if supine). Drift is scored if the arm falls before 10 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic arm. Only in the case of amputation or joint fusion at the shoulder, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice.
E: Raise your right arm and keep it straight. Hold it up for 10 seconds.
S: Levante el brazo derecho y mantengalo recto. Sostengalo durante diez segundos.
E: Raise your arms and keep them straight. Hold them up for 10 seconds.
S: Levante los brazos y mantengalos rectos. Sostenlos durante diez segundos.
E: Keep it up! Up! Up!
S: ¡Mantengalos levantados! ¡Hacia arriba! ¡Hacia arriba!
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic leg. Only in the case of amputation or joint fusion at the hip, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice.
E: Raise your left leg and keep it straight. Hold it up for 5 seconds.
S: Levante la pierna izquierda y mantengala recta. Sostengala durante cinco segundos.
E: Keep it up! Up! Up!
S: ¡Mantengala levantada! ¡Hacia arriba! ¡Hacia arriba!
The limb is placed in the appropriate position: hold the leg at 30 degrees (always tested supine). Drift is scored if the leg falls before 5 seconds. The aphasic patient is encouraged using urgency in the voice and pantomime but not noxious stimulation. Each limb is tested in turn, beginning with the non-paretic leg. Only in the case of amputation or joint fusion at the hip, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice.
E: Raise your right leg and keep it straight. Hold it up for 5 seconds.
S: Levante la pierna derecha y mantengala recta. Sostengala durante cinco segundos.
E: Keep it up! Up! Up!
S: ¡Mantengala levantada! ¡Hacia arriba! ¡Hacia arriba!
This item is aimed at finding evidence of a unilateral cerebellar lesion. Test with eyes open. In case of visual defect, ensure testing is done in intact visual field. The finger-nose-finger and heel-shin tests are performed on both sides, and ataxia is scored only if present out of proportion to weakness. Ataxia is absent in the patient who cannot understand or is paralyzed. Only in the case of amputation or joint fusion, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice. In case of blindness, test by having the patient touch nose from extended arm position.
E: Use your left hand to touch your nose. Touch my finger. Touch your nose. Touch my finger.
S: Usa su mano izquierda para tocarse la nariz. Toque mi dedo. Toquese la nariz. Toque mi dedo.
E: Use your right hand to touch your nose. Touch my finger. Touch your nose. Touch my finger.
S: Usa su mano derecha para tocarse la nariz. Toque mi dedo. Toquese la nariz. Toque mi dedo.
E: Use your left heel to touch your right knee. Slide your foot down. Slide it up. Slide it down.
S: Use el talón izquierdo para tocarse la rodilla derecha. Deslize el pie hacia abajo. Deslízelo hacia arriba. Deslízelo hacia abajo.
E: Use your right heel to touch your left knee. Slide your foot down. Slide it up. Slide it down.
S: Use el talón derecho para tocarse la rodilla izquierda. Deslize el pie hacia abajo. Deslízelo hacia arriba. Deslízelo hacia abajo.
Sensation or grimace to pinprick when tested, or withdrawal from noxious stimulus in the obtunded or aphasic patient. Only sensory loss attributed to stroke is scored as abnormal and the examiner should test as many body areas (arms [not hands], legs, trunk, face) as needed to accurately check for hemisensory loss. A score of 2, "severe or total sensory loss," should only be given when a severe or total loss of sensation can be clearly demonstrated. Stuporous and aphasic patients will, therefore, probably score 1 or 0. The patient with brainstem stroke who has bilateral loss of sensation is scored 2. If the patient does not respond and is quadriplegic, score 2. Patients in a coma (item 1a=3) are automatically given a 2 on this item.
E: Close your eyes. Keep them closed. Point to the side I am touching. Which side? Which side? Which side?
S: Cierre los ojos. Mantengalos cerrados. Señale el lado que estoy tocando. ¿De qué lado? ¿De qué lado? ¿De qué lado?
E: Close your eyes. Keep them closed. Am I touching the right, left, or both sides? Which side? Which side?
S: Cierre los ojos. Mantengalos cerrados. ¿Estoy tocando la derecha, la izquierda o ambos lados? ¿De qué lado? ¿De qué lado?
E: Do you feel this touch? Do you feel this touch? Does it feel the same on both sides? Is it stronger on the right or left?
S: ¿Siente que lo estoy tocando? ¿Siente que lo estoy tocando? ¿Se siente igual en ambos lados? ¿Es más fuerte a la derecha o a la izquierda?
E: Do you feel this pinprick? Do you feel this pinprick? Does it feel the same on both sides? Is it stronger on the right or left?
S: ¿Siente este pinchazo? ¿Siente este pinchazo? ¿Se siente igual en ambos lados? ¿Es más fuerte a la derecha o a la izquierda?
E: Does it feel painful?
S: ¿Siente dolor?
A great deal of information about comprehension will be obtained during the preceding sections of the examination. For this scale item, the patient is asked to describe what is happening in the attached picture, to name items on the naming sheet, and to read from the list of sentences. Comprehension is judged from responses here, as well as to all of the commands in the preceding general neurological exam. If visual loss interferes with the tests, ask the patient to identify objects placed in the hand, repeat, and produce speech. The intubated patient should be asked to write. The patient in a coma (item 1a=3) will automatically score 3 on this item. The examiner must choose a score for the patient with stupor or limited cooperation, but a score of 3 should be used only if the patient is mute and follows no one-step commands.
E: Describe what you see in this picture.
S: Describa lo que ve en esta imagen.
E. Name the items in this picture.
S: Asigne un nombre a los objetos de esta imagen.
E: What is this? What is this? What is this? What is this? What is this?
S: ¿Qué es esto? ¿Qué es esto? ¿Qué es esto? ¿Qué es esto? ¿Qué es esto?
E: Point to the bucket. Point to the bicycle. Point to the cloud. Point to the traffic light. Point to the leaf. Point to the mouse. Point to the bridge.
S: Señale el cubo. Señale la bicicleta. Señale la nube. Señale el semáforo. Señale la hoja. Señale el mouse. Señale el puente.
E: Point to the glove. Point to the key. Point to the cactus. Point to the feather. Point to the chair. Point to the hammock.
S: Señale el guante. Señale la llave. Señale el cactus. Señale la pluma. Señale la silla. Señale la hamaca.
E: Read these sentences.
S: Lea en voz alta las siguientes frases.
If patient is thought to be normal, an adequate sample of speech must be obtained by asking patient to read or repeat words from the attached list. If the patient has severe aphasia, the clarity of articulation of spontaneous speech can be rated. Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice. Do not tell the patient why he or she is being tested.
E: Read these words.
S: Lea en voz alta las siguientes palabras.
E: Say, "mama". Say, "tic tac toe". Say, "half and half". Say, "thank you". Say, "tree". Say, "soccer player".
S: Diga, "mama". Diga, "tic tac toe". Diga, "mitad y mitad". Diga, "gracias". Diga, "árbol". Diga, "futbolista".
E (to family/friend): Does their speech sound normal to you?
S (a la familia/amigo): ¿La manera como habla (el paciente) le suena normal?
Sufficient information to identify neglect may be obtained during the prior testing. If the patient has a severe visual loss preventing visual double simultaneous stimulation, and the cutaneous stimuli are normal, the score is normal. If the patient has aphasia but does appear to attend to both sides, the score is normal. The presence of visual spatial neglect or anosagnosia may also be taken as evidence of abnormality. Since the abnormality is scored only if present, the item is never untestable.
E: Look at my nose. How many fingers do you see? How many? How many? How many?
S: Mire mi nariz. ¿Cuantos dedos ves? ¿Cuantos dedos? ¿Cuantos dedos? ¿Cuantos dedos?
E: Look at my nose. Point to the side I am wiggling. Which side? Which side? Which side?
S: Mire mi nariz. Señale que mano estoy moviendo. ¿De qué lado? ¿De qué lado? ¿De qué lado?
E: Look at my nose. Am I wiggling my fingers on the right, left, or both sides? Which side? Which side?
S: Mire mi nariz. ¿Estoy moviendo mis dedos hacia la derecha, la izquierda, o ambos lados? ¿De qué lado? ¿De qué lado?
E: Close your eyes. Keep them closed. Point to the side I am touching. Which side? Which side? Which side?
S: Cierre los ojos. Mantengalos cerrados. Señale el lado que estoy tocando. ¿De qué lado? ¿De qué lado? ¿De qué lado?
E: Close your eyes. Keep them closed. Am I touching the right, left, or both sides? Which side? Which side?
S: Cierre los ojos. Mantengalos cerrados. ¿Estoy tocando la derecha, la izquierda o ambos lados? ¿De qué lado? ¿De qué lado?
Total Current Score:
