APEX NIH Stroke Scale GROUP C (V5)
Answer Key for Patients 1 through 6 -
Complete NIHSS Clinical Case Series with
Scores, Severity & Deficit Analysis | Latest
Edition – Updated 2026
Patient C1 - Highest Acuity in Group C
Total Score: 20
Severity: Moderate-to-Severe Stroke
Dominant Deficit Pattern: Dense right-sided hemiplegia (arm and leg completely
flaccid) with global aphasia, complete visual field loss, severe sensory loss, and
partial gaze palsy. This patient requires immediate, aggressive intervention.
Item Domain Score Clinical Description
1a LOC 0 Fully alert.
1b LOC Questions 2 Significant: Answers neither question
correctly.
1c LOC Commands 1 Performs one command correctly.
2 Best Gaze 0 Normal horizontal eye movements.
3 Visual Fields 2 Significant: Complete hemianopia.
4 Facial Palsy 1 Minor facial asymmetry.
5a Motor Arm (Left) 0 No drift; normal strength.
5b Motor Arm 4 Critical: No movement at all (flaccid).
(Right)
6a Motor Leg (Left) 0 No drift; normal strength.
pg. 1
, 6b Motor Leg (Right) 4 Critical: No movement at all (flaccid).
7 Limb Ataxia 1 Ataxia present in one limb.
8 Sensory 2 Severe: Total or near-total sensory loss.
9 Best Language 2 Significant: Severe aphasia; fragmented,
effortful speech.
10 Dysarthria 1 Mild-to-moderate slurring; speech is still
understandable.
11 Extinction/Neglect 0 No neglect or inattention.
Patient C2
Total Score: 4
Severity: Minor Stroke
Dominant Deficit Pattern: Mild bilateral leg weakness (right greater than left)
with mild sensory loss. All other domains, including arms and language, are
completely intact.
Item Domain Score Clinical Description
1a LOC 0 Fully alert.
1b LOC Questions 0 Answers both correctly.
1c LOC Commands 0 Performs both commands.
2 Best Gaze 0 Normal horizontal eye movements.
3 Visual Fields 0 No visual loss.
4 Facial Palsy 0 Normal symmetrical movement.
5a Motor Arm (Left) 0 No drift; normal strength.
5b Motor Arm 0 No drift; normal strength.
(Right)
pg. 2
Answer Key for Patients 1 through 6 -
Complete NIHSS Clinical Case Series with
Scores, Severity & Deficit Analysis | Latest
Edition – Updated 2026
Patient C1 - Highest Acuity in Group C
Total Score: 20
Severity: Moderate-to-Severe Stroke
Dominant Deficit Pattern: Dense right-sided hemiplegia (arm and leg completely
flaccid) with global aphasia, complete visual field loss, severe sensory loss, and
partial gaze palsy. This patient requires immediate, aggressive intervention.
Item Domain Score Clinical Description
1a LOC 0 Fully alert.
1b LOC Questions 2 Significant: Answers neither question
correctly.
1c LOC Commands 1 Performs one command correctly.
2 Best Gaze 0 Normal horizontal eye movements.
3 Visual Fields 2 Significant: Complete hemianopia.
4 Facial Palsy 1 Minor facial asymmetry.
5a Motor Arm (Left) 0 No drift; normal strength.
5b Motor Arm 4 Critical: No movement at all (flaccid).
(Right)
6a Motor Leg (Left) 0 No drift; normal strength.
pg. 1
, 6b Motor Leg (Right) 4 Critical: No movement at all (flaccid).
7 Limb Ataxia 1 Ataxia present in one limb.
8 Sensory 2 Severe: Total or near-total sensory loss.
9 Best Language 2 Significant: Severe aphasia; fragmented,
effortful speech.
10 Dysarthria 1 Mild-to-moderate slurring; speech is still
understandable.
11 Extinction/Neglect 0 No neglect or inattention.
Patient C2
Total Score: 4
Severity: Minor Stroke
Dominant Deficit Pattern: Mild bilateral leg weakness (right greater than left)
with mild sensory loss. All other domains, including arms and language, are
completely intact.
Item Domain Score Clinical Description
1a LOC 0 Fully alert.
1b LOC Questions 0 Answers both correctly.
1c LOC Commands 0 Performs both commands.
2 Best Gaze 0 Normal horizontal eye movements.
3 Visual Fields 0 No visual loss.
4 Facial Palsy 0 Normal symmetrical movement.
5a Motor Arm (Left) 0 No drift; normal strength.
5b Motor Arm 0 No drift; normal strength.
(Right)
pg. 2
