NIH STROKE SCALE EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2024/2025

Score for large strokes - Answer > 10 (however, if it is a brainstem stroke it can have a low score and still be a large stroke) Lowest score Highest score - Answer Lowest score is 0 Highest score is 42 Components of *Eyes* - Answer Gaze - voluntary gaze direction (non-comatose) - vestibule-ocular reflex (comatose) Visual fields - confrontation, all 4 quadrants (non-comatose) - threat (comatose) Components of *LOC* - Answer Arousal Questions - name - month Commands - open eyes - grip/release Components of *Face* - Answer Facial droop - smile & eyebrow raise (normal LOC / drowsy) - grimace w/ pain (obtunded) Components of *Motor Strength* - Answer Arm strength - raise arms 45° (supine) - raise arms 90° (sitting) Leg strength - raise legs 30° (always test supine) Components of *Limb Ataxia* - Answer Finger→nose & Heel→shin Components of *Sensory* - Answer Pinprick - all 4 limbs; up to elbow Components of *Language* - Answer Aphasia - describe picture; name objects (w/ adequate vision) - describe large objects in room or ask questions (w/ inadequate vision) Components of *Dysarthria* - Answer Character of speech - read sentences / words (w/ adequate vision) - repeat "methodist episcopal" (w/ inadequate vision) - listen for slurred, garbled, incoherent Components of *Extinction/Inattention* - Answer Vision extinction: - look at wiggling hand Sensory test - upper & lower extensors Special Cases - Answer Unconscious patients will have a high score; does *NOT* mean they had a stroke NIH stroke scale is heavily weighted for *aphasic left hemisphere MCA* stroke. Brainstem stroke could have a low score and have a serious stroke. Isolated gaze palsy (+1) If the patient has unilateral blindness or enucleation, use the remaining eye's visual fields Amputation or joint fusion get score of "UN" for strength & limb ataxia becaues they can not perform (make sure to document why) Aphasic Pt can be encouraged during strength exam w/ pantomime or urgency, but *NOT* noxious stimulation