NIH STROKE SCALE GROUP A Patient
1-6 Complete Answers & Rationales
National Institutes of Health Stroke Scale
(NIHSS) Certification
INSTRUCTIONS
This comprehensive guide provides the complete answers and detailed
rationales for the NIH Stroke Scale Group A (Patients 1-6) . The NIHSS is a
standardized tool used to quantify the severity of stroke-related
neurological deficits. It is widely used in clinical practice and for stroke
certification.
The NIHSS consists of 11 items:
1. Level of Consciousness (LOC)
2. LOC Questions
3. LOC Commands
4. Best Gaze
5. Visual
6. Facial Palsy
7. Motor Arm
8. Motor Leg
9. Limb Ataxia
10. Sensory
11. Best Language
12. Dysarthria
13. Extinction & Inattention
,Scoring: 0 = Normal, 1-4 = Mild to Moderate, 5-15 = Moderate, 16-20 =
Moderate to Severe, 21-42 = Severe
PATIENT 1
Scenario Overview
Patient 1 is a 62-year-old male who presents with right-sided weakness and
speech difficulty. Symptoms began 2 hours ago. He is alert and oriented.
1. Level of Consciousness (LOC):
A) 0 - Alert; keenly responsive
B) 1 - Not alert; but arousable by minor stimulation
C) 2 - Not alert; requires repeated stimulation or is obtunded
D) 3 - Responds only with reflex motor or autonomic effects or totally
unresponsive
Correct Answer: A (0)
Rationale: The patient is alert and oriented, answering questions
appropriately. No deficits in level of consciousness are noted. He responds
to questions and commands without difficulty.
2. LOC Questions:
A) 0 - Answers both correctly
B) 1 - Answers one correctly
C) 2 - Answers neither correctly
Correct Answer: A (0)
Rationale: The patient is asked two questions: "What month is it?" and
,"How old are you?" He answers both correctly. This indicates intact
orientation and no aphasia.
3. LOC Commands:
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
Correct Answer: A (0)
Rationale: The patient is asked to "Open and close your eyes" and "Grip and
release your hand." He performs both tasks without difficulty, indicating
intact motor function and comprehension.
4. Best Gaze:
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation
Correct Answer: A (0)
Rationale: The patient's extraocular movements are intact. Both eyes move
conjugately, and there is no forced deviation or gaze palsy. He can follow
the examiner's finger through all fields of gaze.
5. Visual:
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
, Correct Answer: A (0)
Rationale: The patient's visual fields are intact. He is able to see and count
fingers in all four quadrants bilaterally. There is no visual field deficit.
6. Facial Palsy:
A) 0 - Normal
B) 1 - Minor paralysis (flattened nasolabial fold)
C) 2 - Partial paralysis (total or near-total)
D) 3 - Complete paralysis
Correct Answer: B (1)
Rationale: The patient has flattening of the right nasolabial fold with slight
asymmetry when smiling. This indicates a minor facial palsy. He can still
raise both eyebrows and close both eyes.
7. Motor Arm - Left:
A) 0 - No drift
B) 1 - Drift before 10 seconds
C) 2 - Some effort against gravity
D) 3 - No effort against gravity
E) 4 - No movement
Correct Answer: A (0)
Rationale: The left arm is held at 90 degrees for 10 seconds with no drift.
Motor function is intact on the left side.
8. Motor Arm - Right:
A) 0 - No drift
B) 1 - Drift before 10 seconds
C) 2 - Some effort against gravity
1-6 Complete Answers & Rationales
National Institutes of Health Stroke Scale
(NIHSS) Certification
INSTRUCTIONS
This comprehensive guide provides the complete answers and detailed
rationales for the NIH Stroke Scale Group A (Patients 1-6) . The NIHSS is a
standardized tool used to quantify the severity of stroke-related
neurological deficits. It is widely used in clinical practice and for stroke
certification.
The NIHSS consists of 11 items:
1. Level of Consciousness (LOC)
2. LOC Questions
3. LOC Commands
4. Best Gaze
5. Visual
6. Facial Palsy
7. Motor Arm
8. Motor Leg
9. Limb Ataxia
10. Sensory
11. Best Language
12. Dysarthria
13. Extinction & Inattention
,Scoring: 0 = Normal, 1-4 = Mild to Moderate, 5-15 = Moderate, 16-20 =
Moderate to Severe, 21-42 = Severe
PATIENT 1
Scenario Overview
Patient 1 is a 62-year-old male who presents with right-sided weakness and
speech difficulty. Symptoms began 2 hours ago. He is alert and oriented.
1. Level of Consciousness (LOC):
A) 0 - Alert; keenly responsive
B) 1 - Not alert; but arousable by minor stimulation
C) 2 - Not alert; requires repeated stimulation or is obtunded
D) 3 - Responds only with reflex motor or autonomic effects or totally
unresponsive
Correct Answer: A (0)
Rationale: The patient is alert and oriented, answering questions
appropriately. No deficits in level of consciousness are noted. He responds
to questions and commands without difficulty.
2. LOC Questions:
A) 0 - Answers both correctly
B) 1 - Answers one correctly
C) 2 - Answers neither correctly
Correct Answer: A (0)
Rationale: The patient is asked two questions: "What month is it?" and
,"How old are you?" He answers both correctly. This indicates intact
orientation and no aphasia.
3. LOC Commands:
A) 0 - Performs both tasks correctly
B) 1 - Performs one task correctly
C) 2 - Performs neither task correctly
Correct Answer: A (0)
Rationale: The patient is asked to "Open and close your eyes" and "Grip and
release your hand." He performs both tasks without difficulty, indicating
intact motor function and comprehension.
4. Best Gaze:
A) 0 - Normal
B) 1 - Partial gaze palsy
C) 2 - Forced deviation
Correct Answer: A (0)
Rationale: The patient's extraocular movements are intact. Both eyes move
conjugately, and there is no forced deviation or gaze palsy. He can follow
the examiner's finger through all fields of gaze.
5. Visual:
A) 0 - No visual loss
B) 1 - Partial hemianopia
C) 2 - Complete hemianopia
D) 3 - Bilateral hemianopia
, Correct Answer: A (0)
Rationale: The patient's visual fields are intact. He is able to see and count
fingers in all four quadrants bilaterally. There is no visual field deficit.
6. Facial Palsy:
A) 0 - Normal
B) 1 - Minor paralysis (flattened nasolabial fold)
C) 2 - Partial paralysis (total or near-total)
D) 3 - Complete paralysis
Correct Answer: B (1)
Rationale: The patient has flattening of the right nasolabial fold with slight
asymmetry when smiling. This indicates a minor facial palsy. He can still
raise both eyebrows and close both eyes.
7. Motor Arm - Left:
A) 0 - No drift
B) 1 - Drift before 10 seconds
C) 2 - Some effort against gravity
D) 3 - No effort against gravity
E) 4 - No movement
Correct Answer: A (0)
Rationale: The left arm is held at 90 degrees for 10 seconds with no drift.
Motor function is intact on the left side.
8. Motor Arm - Right:
A) 0 - No drift
B) 1 - Drift before 10 seconds
C) 2 - Some effort against gravity
