PASSPOINT PRO
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale (NIHSS) Groups A-F
Complete Study & Scoring Guide
Scoring framework, administration guidance, high-yield traps, and 60
guided practice questions.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-01
,PASSPOINT PRO NIHSS Complete Guide
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
NIHSS Item Map
Item Domain Score range High-yield focus
1a Level of Consciousness 0-3 Alertness and response to stimulation
1b LOC Questions 0-2 Month and age; first response counts
1c LOC Commands 0-2 Two simple commands
2 Best Gaze 0-2 Horizontal gaze and forced deviation
3 Visual Fields 0-3 Field loss and bilateral blindness
4 Facial Palsy 0-3 Minor vs partial vs complete facial weakness
5L Motor Arm - Left 0-4 10-second arm drift
5R Motor Arm - Right 0-4 10-second arm drift
6L Motor Leg - Left 0-4 5-second leg drift
6R Motor Leg - Right 0-4 5-second leg drift
7 Limb Ataxia 0-2 Ataxia beyond weakness
8 Sensory 0-2 Mild vs severe sensory loss
9 Best Language 0-3 Language, naming, comprehension
10 Dysarthria 0-2 Articulation clarity
11 Extinction/Inattention 0-2 Extinction and hemi-inattention
NIHSS exam-prep and scoring practice Page 2
, PASSPOINT PRO NIHSS Complete Guide
Section 1 - Scoring Guide by Item
1a. Level of Consciousness
Score 0: Alert and readily responsive.
Score 1: Not fully alert but becomes responsive with minor stimulation.
Score 2: Requires repeated or strong stimulation to attend, or is markedly obtunded.
Score 3: Responds only with reflexive motor/autonomic activity or is completely unresponsive.
1b. LOC Questions
Score 0: Both orientation questions are answered correctly.
Score 1: Only one orientation question is answered correctly.
Score 2: Neither orientation question is answered correctly.
1c. LOC Commands
Score 0: Both simple commands are performed correctly.
Score 1: Only one command is performed correctly.
Score 2: Neither command is performed correctly.
2. Best Gaze
Score 0: Horizontal eye movements are normal.
Score 1: There is a partial gaze palsy or abnormal gaze in one or both eyes without forced deviation.
Score 2: There is forced eye deviation or total gaze paresis not overcome by standard maneuvers.
3. Visual Fields
Score 0: No visual field loss is detected.
Score 1: Partial hemianopia or consistent visual field asymmetry is present.
Score 2: Complete hemianopia is present.
Score 3: Bilateral hemianopia, including cortical blindness, is present.
4. Facial Palsy
Score 0: Facial movement is symmetric.
Score 1: Minor facial weakness such as a flattened nasolabial fold or asymmetry on smiling.
Score 2: Partial facial paralysis, especially of the lower face.
Score 3: Complete unilateral or bilateral facial paralysis affecting upper and lower face.
5L. Motor Arm - Left
Score 0: Left arm holds the required position without drift.
Score 1: Left arm drifts but does not hit the support before 10 seconds.
Score 2: Left arm has some effort against gravity but cannot maintain the position for 10 seconds.
Score 3: Left arm shows no effort against gravity.
Score 4: No movement is seen in the left arm.
Exam trap: Arm drift is judged over 10 seconds. Do not use the leg timing.
NIHSS exam-prep and scoring practice Page 3
NIH STROKE SCALE STUDY SERIES
NIH Stroke Scale (NIHSS) Groups A-F
Complete Study & Scoring Guide
Scoring framework, administration guidance, high-yield traps, and 60
guided practice questions.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-01
,PASSPOINT PRO NIHSS Complete Guide
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
NIHSS Item Map
Item Domain Score range High-yield focus
1a Level of Consciousness 0-3 Alertness and response to stimulation
1b LOC Questions 0-2 Month and age; first response counts
1c LOC Commands 0-2 Two simple commands
2 Best Gaze 0-2 Horizontal gaze and forced deviation
3 Visual Fields 0-3 Field loss and bilateral blindness
4 Facial Palsy 0-3 Minor vs partial vs complete facial weakness
5L Motor Arm - Left 0-4 10-second arm drift
5R Motor Arm - Right 0-4 10-second arm drift
6L Motor Leg - Left 0-4 5-second leg drift
6R Motor Leg - Right 0-4 5-second leg drift
7 Limb Ataxia 0-2 Ataxia beyond weakness
8 Sensory 0-2 Mild vs severe sensory loss
9 Best Language 0-3 Language, naming, comprehension
10 Dysarthria 0-2 Articulation clarity
11 Extinction/Inattention 0-2 Extinction and hemi-inattention
NIHSS exam-prep and scoring practice Page 2
, PASSPOINT PRO NIHSS Complete Guide
Section 1 - Scoring Guide by Item
1a. Level of Consciousness
Score 0: Alert and readily responsive.
Score 1: Not fully alert but becomes responsive with minor stimulation.
Score 2: Requires repeated or strong stimulation to attend, or is markedly obtunded.
Score 3: Responds only with reflexive motor/autonomic activity or is completely unresponsive.
1b. LOC Questions
Score 0: Both orientation questions are answered correctly.
Score 1: Only one orientation question is answered correctly.
Score 2: Neither orientation question is answered correctly.
1c. LOC Commands
Score 0: Both simple commands are performed correctly.
Score 1: Only one command is performed correctly.
Score 2: Neither command is performed correctly.
2. Best Gaze
Score 0: Horizontal eye movements are normal.
Score 1: There is a partial gaze palsy or abnormal gaze in one or both eyes without forced deviation.
Score 2: There is forced eye deviation or total gaze paresis not overcome by standard maneuvers.
3. Visual Fields
Score 0: No visual field loss is detected.
Score 1: Partial hemianopia or consistent visual field asymmetry is present.
Score 2: Complete hemianopia is present.
Score 3: Bilateral hemianopia, including cortical blindness, is present.
4. Facial Palsy
Score 0: Facial movement is symmetric.
Score 1: Minor facial weakness such as a flattened nasolabial fold or asymmetry on smiling.
Score 2: Partial facial paralysis, especially of the lower face.
Score 3: Complete unilateral or bilateral facial paralysis affecting upper and lower face.
5L. Motor Arm - Left
Score 0: Left arm holds the required position without drift.
Score 1: Left arm drifts but does not hit the support before 10 seconds.
Score 2: Left arm has some effort against gravity but cannot maintain the position for 10 seconds.
Score 3: Left arm shows no effort against gravity.
Score 4: No movement is seen in the left arm.
Exam trap: Arm drift is judged over 10 seconds. Do not use the leg timing.
NIHSS exam-prep and scoring practice Page 3
