NIH STROKE SCALE UPDATED PRACTICE EXAM
2026 STUDY GUIDE TESTED QUESTIONS AND
ANSWERS
◉ 1B. Level of Consciousness (LOC) Scoring Answer: The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the
questions are scored 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 scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
◉ 1C. Level of Consciousness (LOC) Scoring Answer: 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. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
, ◉ 2. Best Gaze NIHSS Scoring Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze
palsy.
0 - Normal
1 - Partial gaze palsy; gaze is abnormal in one or both eyes, but
forced deviation or total gaze paresis is not present
2 - Forced deviation, or total gaze paresis is not overcome by the
oculocephalic maneuver.
◉ 3 Visual NIHSS Scoring Answer: Visual fields (upper and lower
quadrants) are tested by confrontation, using finger counting or
visual threat, as appropriate. Have pt cover individual eye and look
at your nose. Flash numbers in peripheral vision.
0 - No visual loss
1 - Partial hemianopia (loss of half of visions field)
2 - Complete hemianopia
3 - Bilateral hemianopia (blind including cortical blindness)
◉ 4 Facial Palsy NIHSS Scoring Answer: Ask pt to show teeth or raise
eyebrows and close eyes. Score symmetry of grimace.
2026 STUDY GUIDE TESTED QUESTIONS AND
ANSWERS
◉ 1B. Level of Consciousness (LOC) Scoring Answer: The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the
questions are scored 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 scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
◉ 1C. Level of Consciousness (LOC) Scoring Answer: 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. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
, ◉ 2. Best Gaze NIHSS Scoring Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze
palsy.
0 - Normal
1 - Partial gaze palsy; gaze is abnormal in one or both eyes, but
forced deviation or total gaze paresis is not present
2 - Forced deviation, or total gaze paresis is not overcome by the
oculocephalic maneuver.
◉ 3 Visual NIHSS Scoring Answer: Visual fields (upper and lower
quadrants) are tested by confrontation, using finger counting or
visual threat, as appropriate. Have pt cover individual eye and look
at your nose. Flash numbers in peripheral vision.
0 - No visual loss
1 - Partial hemianopia (loss of half of visions field)
2 - Complete hemianopia
3 - Bilateral hemianopia (blind including cortical blindness)
◉ 4 Facial Palsy NIHSS Scoring Answer: Ask pt to show teeth or raise
eyebrows and close eyes. Score symmetry of grimace.
