NIH STROKE SCALE GROUP A PATIENT 1 TO 6
EXAM 2026 COMPREHENSIVE STUDY AND
ANSWER GUIDE
◉ item 3, ask patient to do what. Answer: count fingers in all four
quadrants
◉ Item 3 - if a patient scored 3 on item 1a, they are tested for 3 using
what? and what is it?. Answer: bilateral threat
◉ NIH scale 3 scoring:
0
1
2
3. Answer: 0- no visual loss, upper and lower visual fields are normal
1- clear cut asymetry, including quadrantanopia or partial
hemianopia
2-complete hemianopia
3-bilateral hemianopia (blindness of any cause including cortical
blindness)
,◉ item 3: if patient has severe monocular visual loss d/t intrinsic
eye disease and visual fields in other eye are normal, examiner
should score as. Answer: normal
◉ if there is unilateral blindness or enucleation, what is scored.
Answer: visual fields in the remaining eye
◉ arbitrary rule that if they extinguish even if intact to
confrontation, visual field item is scored as a.... Answer: 1
◉ NIH item 4 is.... Answer: facial palsy
◉ in NIH #4,you ask patient. Answer: "show me your teeth," if no
teeth in say "show me your gums"
"open and close your eyes" - can say "squeeze eyes shut as hard as
you can"
"raise the eyebrows" or "lift up your eyebrows as much as you can"
◉ for NIH 4, where MUST patient look?. Answer: directly at
examiner
◉ NIH 4: for aphasic, poorly responsive or noncomprehending
patient, use what kind of stimulus?
, If using this stimulus, what is the basis for the scoring?. Answer:
noxious
-the symmetry of the grimace
◉ NIH Item #4 Scoring
0
1
2
3. Answer: 0 - normal symmetrical movement
1 - minor paralysis such as a flattened nasolabial fold or mild
asymmetry while smiling - proper score if function is less than
clearly normal
2-paralysis of the lower face - appropriate for clear cut upper motor
neuron facial palsy
3- complete paralysis of the upper and lower face - appropriate
score for obtunded or comatose patient or one with unilateral-lower
motor neuron facial weakness
◉ decreased spontaneous and forced facial movements are most
prominent at what location?. Answer: the mouth
◉ if there is a clear cut asymmetry of the smile, the score is....
Answer: two, all other subtle asymmetries are scored as a one
EXAM 2026 COMPREHENSIVE STUDY AND
ANSWER GUIDE
◉ item 3, ask patient to do what. Answer: count fingers in all four
quadrants
◉ Item 3 - if a patient scored 3 on item 1a, they are tested for 3 using
what? and what is it?. Answer: bilateral threat
◉ NIH scale 3 scoring:
0
1
2
3. Answer: 0- no visual loss, upper and lower visual fields are normal
1- clear cut asymetry, including quadrantanopia or partial
hemianopia
2-complete hemianopia
3-bilateral hemianopia (blindness of any cause including cortical
blindness)
,◉ item 3: if patient has severe monocular visual loss d/t intrinsic
eye disease and visual fields in other eye are normal, examiner
should score as. Answer: normal
◉ if there is unilateral blindness or enucleation, what is scored.
Answer: visual fields in the remaining eye
◉ arbitrary rule that if they extinguish even if intact to
confrontation, visual field item is scored as a.... Answer: 1
◉ NIH item 4 is.... Answer: facial palsy
◉ in NIH #4,you ask patient. Answer: "show me your teeth," if no
teeth in say "show me your gums"
"open and close your eyes" - can say "squeeze eyes shut as hard as
you can"
"raise the eyebrows" or "lift up your eyebrows as much as you can"
◉ for NIH 4, where MUST patient look?. Answer: directly at
examiner
◉ NIH 4: for aphasic, poorly responsive or noncomprehending
patient, use what kind of stimulus?
, If using this stimulus, what is the basis for the scoring?. Answer:
noxious
-the symmetry of the grimace
◉ NIH Item #4 Scoring
0
1
2
3. Answer: 0 - normal symmetrical movement
1 - minor paralysis such as a flattened nasolabial fold or mild
asymmetry while smiling - proper score if function is less than
clearly normal
2-paralysis of the lower face - appropriate for clear cut upper motor
neuron facial palsy
3- complete paralysis of the upper and lower face - appropriate
score for obtunded or comatose patient or one with unilateral-lower
motor neuron facial weakness
◉ decreased spontaneous and forced facial movements are most
prominent at what location?. Answer: the mouth
◉ if there is a clear cut asymmetry of the smile, the score is....
Answer: two, all other subtle asymmetries are scored as a one
