NIH Stroke Scale Group B Patient 1-6
Answer key
Patient 1
Patient Presentation: 71-year-old white male with acute onset of right-sided weakness and
speech difficulty.
Patient 1 - Question 1
1a. Level of Consciousness (LOC): The patient is alert and responsive. He answers questions
appropriately and follows commands.
• A) 0 - Alert; keenly responsive
• B) 1 - Not alert, but arousable by minor stimulation
• C) 2 - Not alert, requires repeated stimulation
• D) 3 - Responds only with reflex motor or autonomic effects
Answer: A
Rationale: The patient is described as alert and responsive, indicating a score of 0. In the NIHSS,
0 = Alert, keenly responsive; 1 = Not alert, but arousable by minor stimulation; 2 = Not alert,
requires repeated stimulation; 3 = Responds only with reflex motor or autonomic effects.
Patient 1 - Question 2
1b. LOC Questions: The patient is asked his age and the current month. He answers his age
correctly but cannot recall the current month.
• A) 0 - Answers both correctly
• B) 1 - Answers one correctly
• C) 2 - Answers neither correctly
• D) 3 - Unable to respond
Answer: B
Rationale: The patient answers one question correctly (his age) but answers the second
incorrectly (the month), so the score is 1 out of 2.
,Patient 1 - Question 3
1c. LOC Commands: The patient is asked to open and close his eyes and then to grip and release
his non-paretic hand. He performs both tasks correctly.
• A) 0 - Performs both tasks correctly
• B) 1 - Performs one task correctly
• C) 2 - Performs neither task correctly
• D) 3 - Unable to respond
Answer: A
Rationale: The patient performs both tasks correctly, scoring 0. If the patient is unable to
perform the task due to weakness, the score is based on the best performance possible.
Patient 1 - Question 4
2. Best Gaze: The patient's eyes move conjugately in all directions. There is no forced deviation.
• A) 0 - Normal
• B) 1 - Partial gaze palsy
• C) 2 - Forced deviation
Answer: A
Rationale: The patient has full, conjugate eye movements, scoring 0. Gaze palsy is scored as 1
(partial) or 2 (forced deviation).
Patient 1 - Question 5
3. Visual: The patient has no visual field deficits on confrontation testing.
• A) 0 - No visual loss
• B) 1 - Partial hemianopia
• C) 2 - Complete hemianopia
• D) 3 - Bilateral hemianopia
, Answer: A
Rationale: The patient has no visual field deficits, scoring 0. Visual fields are tested by
confrontation.
Patient 1 - Question 6
4. Facial Palsy: The patient has mild facial asymmetry with a slight droop on the right side.
• A) 0 - Normal
• B) 1 - Minor paralysis
• C) 2 - Partial paralysis
• D) 3 - Complete paralysis
Answer: B
Rationale: The patient has mild facial asymmetry with a slight droop, indicating minor paralysis
(score 1). This is consistent with a left hemisphere stroke affecting the facial nerve.
Patient 1 - Question 7
5a. Motor Arm - Left: The patient extends the left arm and holds it at 90 degrees for 10 seconds
without drift.
• A) 0 - No drift
• B) 1 - Drift
• C) 2 - Some effort against gravity
• D) 3 - No effort against gravity
• E) 4 - No movement
Answer: A
Rationale: The patient holds the left arm without drift, scoring 0. The arm is tested with palm
down at 90 degrees if sitting or 45 degrees if supine.
Patient 1 - Question 8
Answer key
Patient 1
Patient Presentation: 71-year-old white male with acute onset of right-sided weakness and
speech difficulty.
Patient 1 - Question 1
1a. Level of Consciousness (LOC): The patient is alert and responsive. He answers questions
appropriately and follows commands.
• A) 0 - Alert; keenly responsive
• B) 1 - Not alert, but arousable by minor stimulation
• C) 2 - Not alert, requires repeated stimulation
• D) 3 - Responds only with reflex motor or autonomic effects
Answer: A
Rationale: The patient is described as alert and responsive, indicating a score of 0. In the NIHSS,
0 = Alert, keenly responsive; 1 = Not alert, but arousable by minor stimulation; 2 = Not alert,
requires repeated stimulation; 3 = Responds only with reflex motor or autonomic effects.
Patient 1 - Question 2
1b. LOC Questions: The patient is asked his age and the current month. He answers his age
correctly but cannot recall the current month.
• A) 0 - Answers both correctly
• B) 1 - Answers one correctly
• C) 2 - Answers neither correctly
• D) 3 - Unable to respond
Answer: B
Rationale: The patient answers one question correctly (his age) but answers the second
incorrectly (the month), so the score is 1 out of 2.
,Patient 1 - Question 3
1c. LOC Commands: The patient is asked to open and close his eyes and then to grip and release
his non-paretic hand. He performs both tasks correctly.
• A) 0 - Performs both tasks correctly
• B) 1 - Performs one task correctly
• C) 2 - Performs neither task correctly
• D) 3 - Unable to respond
Answer: A
Rationale: The patient performs both tasks correctly, scoring 0. If the patient is unable to
perform the task due to weakness, the score is based on the best performance possible.
Patient 1 - Question 4
2. Best Gaze: The patient's eyes move conjugately in all directions. There is no forced deviation.
• A) 0 - Normal
• B) 1 - Partial gaze palsy
• C) 2 - Forced deviation
Answer: A
Rationale: The patient has full, conjugate eye movements, scoring 0. Gaze palsy is scored as 1
(partial) or 2 (forced deviation).
Patient 1 - Question 5
3. Visual: The patient has no visual field deficits on confrontation testing.
• A) 0 - No visual loss
• B) 1 - Partial hemianopia
• C) 2 - Complete hemianopia
• D) 3 - Bilateral hemianopia
, Answer: A
Rationale: The patient has no visual field deficits, scoring 0. Visual fields are tested by
confrontation.
Patient 1 - Question 6
4. Facial Palsy: The patient has mild facial asymmetry with a slight droop on the right side.
• A) 0 - Normal
• B) 1 - Minor paralysis
• C) 2 - Partial paralysis
• D) 3 - Complete paralysis
Answer: B
Rationale: The patient has mild facial asymmetry with a slight droop, indicating minor paralysis
(score 1). This is consistent with a left hemisphere stroke affecting the facial nerve.
Patient 1 - Question 7
5a. Motor Arm - Left: The patient extends the left arm and holds it at 90 degrees for 10 seconds
without drift.
• A) 0 - No drift
• B) 1 - Drift
• C) 2 - Some effort against gravity
• D) 3 - No effort against gravity
• E) 4 - No movement
Answer: A
Rationale: The patient holds the left arm without drift, scoring 0. The arm is tested with palm
down at 90 degrees if sitting or 45 degrees if supine.
Patient 1 - Question 8
