NIH stroke scale Questions & Answers With Complete Solution

1a LOC - Answer 0: alert 1: not alert; aroused with minor verbal stimulation 2: not alert; requires strong or painful stimulation 3: reflex movements only or totally unresponsive 1b LOC questions - Answer What month is it? What's your age? 0: answers both questions correctly 1: answers one question 2: answers neither question correctly 1c LOC COMMANDS - Answer -close your eyes, now open -make a fist with your hand (can show pt to make a fist) Give credit if attempt is made but not completed do to weakness 0: both tasks performed correctly 1: performs one task correctly 2: neither task is performed correctly 2 BEST GAZE - Answer -have pt track your finger/examiners face 0: normal (if pt has strabismus but eye leaves midline and looks r and l, then normal) 1: partial gaze palsy (if there's conjugate deviation of eyes that can be overcome by voluntary or reflexive activity, abducens palsy) 2: forced deviation (not overcome by the oculocephalic maneuver) 3 VISUAL FIELDS - Answer -tell pt you'll be testing peripheral vision and to look at your nose -have pt count number of fingers you're holding up in all 4 quadrants -cover R eye, ask pt how many fingers they see in all 4 quadrants -cover L eye, repeat 0: no visual loss (if pt confused but looks at fingers, score 0) 1: partial hemianopia (patient recognizes no visual stimulus in ONE specific quadrant) 2: complete hemianopia (patient recognizes no visual stimulus in ONE HALF of the visual field 3: bilateral hemianopia (blind including cortical blindness)