The NIHSS is an ancillary and research tool used for assessing the severity of a stroke. It is not meant to replace a comprehensive neurological examination. Clinical decisions remain the responsibility of the treating physician and should not merely be based on severity score. Follow directions provided for each step. Scores should reflect what the examiner directly observed during the evaluation and should not be based on what the clinician thinks that the patient could do. Answers should be recorded during the clinical evaluation. Except where indicated, the patient should not be coached.