NIH Stroke Scale (NIHSS) Complete
Certification Answer Key
Verified for 2026/2027 | All Groups A-F (Patients 1-6)
GROUP A | PATIENTS 1-6
Patient 1
Scenario: 68-year-old male, alert and oriented, answers both month and age correctly, follows
both commands (eyes open/close, grip/release), normal horizontal gaze, full visual fields,
minor flattening of right nasolabial fold, right arm drifts down before 10 seconds but doesn't
hit bed, left arm holds 90 degrees for full 10 seconds, right leg falls to bed by 5 seconds but has
some effort against gravity, left leg holds 30 degrees for full 5 seconds, no ataxia, mild
decreased sensation to pinprick on right arm and leg compared to left, fluent speech with mild
word-finding difficulty, mild slurring of speech, no neglect.
Ta ble
Item Score Rationale
1a. LOC 0 Alert; keenly responsive
1b. LOC Questions 0 Answers both correctly (month and age)
1c. LOC Commands 0 Performs both tasks correctly
2. Best Gaze 0 Normal horizontal eye movements
3. Visual Fields 0 No visual loss - full to confrontation
4. Facial Palsy 1 Minor paralysis (flattened nasolabial fold R)
5a. Motor Arm Right 1 Drift - holds 90° but drifts before 10 sec
5b. Motor Arm Left 0 No drift - holds full 10 seconds
, Item Score Rationale
6a. Motor Leg Right 2 Some effort against gravity - falls by 5 sec
6b. Motor Leg Left 0 No drift - holds 30° full 5 seconds
7. Limb Ataxia 0 Absent - no cerebellar signs
8. Sensory 1 Mild-moderate sensory loss on right side
9. Best Language 1 Mild-moderate aphasia (word-finding issues)
10. Dysarthria 1 Mild-moderate dysarthria (slurred speech)
11. Extinction/Inattention 0 No abnormality - attends to both sides
TOTAL 7 Minor stroke
Patient 2
Scenario: 55-year-old female, drowsy but arouses to voice (minor stimulation), answers
month correctly but age incorrectly, follows one command (opens eyes) but not grip/release,
partial gaze palsy to the left that can be overcome with tracking, partial hemianopia on right
(misses fingers in upper right quadrant), complete paralysis of left lower face (cannot smile or
show teeth on left), left arm falls immediately with no effort against gravity, right arm
normal, left leg no movement at all, right leg normal, ataxia present in left arm only (finger-
nose-finger past pointing), severe sensory loss on left side (not aware of being touched), mute
with global aphasia (no usable speech, cannot follow commands), severe dysarthria
(unintelligible), profound left-sided neglect (does not recognize own left hand).
Ta ble
Item Score Rationale
1a. LOC 1 Not alert but arousable by minor stimulation
1b. LOC Questions 1 Answers one correctly (month), misses age
, Item Score Rationale
1c. LOC Commands 1 Performs one task correctly (eyes)
2. Best Gaze 1 Partial gaze palsy - overcome with tracking
3. Visual Fields 1 Partial hemianopia (upper right quadrant)
4. Facial Palsy 2 Partial paralysis (left lower face complete)
5a. Motor Arm Left 3 No effort against gravity - limb falls
5b. Motor Arm Right 0 No drift
6a. Motor Leg Left 4 No movement
6b. Motor Leg Right 0 No drift
7. Limb Ataxia 1 Present in one limb (left arm)
8. Sensory 2 Severe to total sensory loss on left
9. Best Language 3 Mute, global aphasia
10. Dysarthria 2 Severe dysarthria (unintelligible)
11. Extinction/Inattention 2 Profound hemi-inattention (left neglect)
TOTAL 21 Severe stroke
Patient 3
Scenario: 72-year-old male, alert, answers neither month nor age correctly (says "Tuesday"
and "45" when he is 72), follows neither command (does not open eyes or grip hand even with
demonstration), forced deviation of eyes to the right that cannot be overcome by
oculocephalic maneuver, complete hemianopia on left, complete paralysis of right face (upper
and lower), right arm no movement, left arm normal, right leg no movement, left leg normal,
, no ataxia, severe sensory loss on right side, severe aphasia (fragmentary expression only),
severe dysarthria, profound right-sided inattention.
Ta ble
Item Score Rationale
1a. LOC 0 Alert (but confused)
1b. LOC Questions 2 Answers neither correctly
1c. LOC Commands 2 Performs neither task correctly
2. Best Gaze 2 Forced deviation not overcome by oculocephalic
3. Visual Fields 2 Complete hemianopia left
4. Facial Palsy 3 Complete paralysis right side
5a. Motor Arm Right 4 No movement
5b. Motor Arm Left 0 No drift
6a. Motor Leg Right 4 No movement
6b. Motor Leg Left 0 No drift
7. Limb Ataxia 0 Absent (paralyzed limbs not scored)
8. Sensory 2 Severe to total loss right side
9. Best Language 2 Severe aphasia
10. Dysarthria 2 Severe dysarthria
11. Extinction/Inattention 2 Profound hemi-inattention right side
TOTAL 23 Severe stroke
Patient 4
Certification Answer Key
Verified for 2026/2027 | All Groups A-F (Patients 1-6)
GROUP A | PATIENTS 1-6
Patient 1
Scenario: 68-year-old male, alert and oriented, answers both month and age correctly, follows
both commands (eyes open/close, grip/release), normal horizontal gaze, full visual fields,
minor flattening of right nasolabial fold, right arm drifts down before 10 seconds but doesn't
hit bed, left arm holds 90 degrees for full 10 seconds, right leg falls to bed by 5 seconds but has
some effort against gravity, left leg holds 30 degrees for full 5 seconds, no ataxia, mild
decreased sensation to pinprick on right arm and leg compared to left, fluent speech with mild
word-finding difficulty, mild slurring of speech, no neglect.
Ta ble
Item Score Rationale
1a. LOC 0 Alert; keenly responsive
1b. LOC Questions 0 Answers both correctly (month and age)
1c. LOC Commands 0 Performs both tasks correctly
2. Best Gaze 0 Normal horizontal eye movements
3. Visual Fields 0 No visual loss - full to confrontation
4. Facial Palsy 1 Minor paralysis (flattened nasolabial fold R)
5a. Motor Arm Right 1 Drift - holds 90° but drifts before 10 sec
5b. Motor Arm Left 0 No drift - holds full 10 seconds
, Item Score Rationale
6a. Motor Leg Right 2 Some effort against gravity - falls by 5 sec
6b. Motor Leg Left 0 No drift - holds 30° full 5 seconds
7. Limb Ataxia 0 Absent - no cerebellar signs
8. Sensory 1 Mild-moderate sensory loss on right side
9. Best Language 1 Mild-moderate aphasia (word-finding issues)
10. Dysarthria 1 Mild-moderate dysarthria (slurred speech)
11. Extinction/Inattention 0 No abnormality - attends to both sides
TOTAL 7 Minor stroke
Patient 2
Scenario: 55-year-old female, drowsy but arouses to voice (minor stimulation), answers
month correctly but age incorrectly, follows one command (opens eyes) but not grip/release,
partial gaze palsy to the left that can be overcome with tracking, partial hemianopia on right
(misses fingers in upper right quadrant), complete paralysis of left lower face (cannot smile or
show teeth on left), left arm falls immediately with no effort against gravity, right arm
normal, left leg no movement at all, right leg normal, ataxia present in left arm only (finger-
nose-finger past pointing), severe sensory loss on left side (not aware of being touched), mute
with global aphasia (no usable speech, cannot follow commands), severe dysarthria
(unintelligible), profound left-sided neglect (does not recognize own left hand).
Ta ble
Item Score Rationale
1a. LOC 1 Not alert but arousable by minor stimulation
1b. LOC Questions 1 Answers one correctly (month), misses age
, Item Score Rationale
1c. LOC Commands 1 Performs one task correctly (eyes)
2. Best Gaze 1 Partial gaze palsy - overcome with tracking
3. Visual Fields 1 Partial hemianopia (upper right quadrant)
4. Facial Palsy 2 Partial paralysis (left lower face complete)
5a. Motor Arm Left 3 No effort against gravity - limb falls
5b. Motor Arm Right 0 No drift
6a. Motor Leg Left 4 No movement
6b. Motor Leg Right 0 No drift
7. Limb Ataxia 1 Present in one limb (left arm)
8. Sensory 2 Severe to total sensory loss on left
9. Best Language 3 Mute, global aphasia
10. Dysarthria 2 Severe dysarthria (unintelligible)
11. Extinction/Inattention 2 Profound hemi-inattention (left neglect)
TOTAL 21 Severe stroke
Patient 3
Scenario: 72-year-old male, alert, answers neither month nor age correctly (says "Tuesday"
and "45" when he is 72), follows neither command (does not open eyes or grip hand even with
demonstration), forced deviation of eyes to the right that cannot be overcome by
oculocephalic maneuver, complete hemianopia on left, complete paralysis of right face (upper
and lower), right arm no movement, left arm normal, right leg no movement, left leg normal,
, no ataxia, severe sensory loss on right side, severe aphasia (fragmentary expression only),
severe dysarthria, profound right-sided inattention.
Ta ble
Item Score Rationale
1a. LOC 0 Alert (but confused)
1b. LOC Questions 2 Answers neither correctly
1c. LOC Commands 2 Performs neither task correctly
2. Best Gaze 2 Forced deviation not overcome by oculocephalic
3. Visual Fields 2 Complete hemianopia left
4. Facial Palsy 3 Complete paralysis right side
5a. Motor Arm Right 4 No movement
5b. Motor Arm Left 0 No drift
6a. Motor Leg Right 4 No movement
6b. Motor Leg Left 0 No drift
7. Limb Ataxia 0 Absent (paralyzed limbs not scored)
8. Sensory 2 Severe to total loss right side
9. Best Language 2 Severe aphasia
10. Dysarthria 2 Severe dysarthria
11. Extinction/Inattention 2 Profound hemi-inattention right side
TOTAL 23 Severe stroke
Patient 4
