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Calculator · Is this a stroke?
ROSIER scale
Recognition Of Stroke In the Emergency Room. Check the glucose first — the scale assumes hypoglycaemia has already been excluded, because a low sugar mimics a stroke well enough to reach the CT scanner.
What it asks
| Criterion | Points |
|---|---|
| Loss of consciousness or syncope | No — 0 Yes — -1 |
| Seizure activity | No — 0 Yes — -1 |
| Asymmetric FACIAL weakness — new, acute onset | No — 0 Yes — 1 |
| Asymmetric ARM weakness — new, acute onset | No — 0 Yes — 1 |
| Asymmetric LEG weakness — new, acute onset | No — 0 Yes — 1 |
| Speech disturbance — new, acute onset | No — 0 Yes — 1 |
| Visual field defect — new, acute onset | No — 0 Yes — 1 |
How to read the score
| Score | Means | What to do |
|---|---|---|
| -2–0 | Stroke unlikely — but not excluded | A score of 0 or less makes stroke unlikely, NOT impossible. Posterior circulation strokes score badly on this scale: isolated vertigo, ataxia or diplopia can score zero and still be a stroke. If the story is sudden and focal, escalate anyway. |
| 1–5 | Stroke likely | Treat as a stroke. Time of onset, immediate imaging, and the thrombolysis or thrombectomy question — a score above zero is a reason to move, not to score again. |
Before you use it
CHECK THE GLUCOSE BEFORE YOU SCORE. Hypoglycaemia produces focal deficits that resolve completely with treatment, and it is the single commonest stroke mimic on a medical take. The scale also assumes a NEW deficit — an old hemiparesis with a new infection scores identically to a stroke, and the history is what tells them apart.
Source: Nor et al, Lancet Neurology 2005; NICE NG128
Checked, and shown
Every threshold on this page was checked against its primary source by a practising doctor. Here is what that involved, and what it found.