NIH Stroke Scale Exam 2025 Questions and
Answers
How to assess Level of Consciousness? - ANS 1a. Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit for being close. Aphasic and stuporous
patients who do not comprehend the questions will score 2. It is important that only the initial
answer be graded and that the examiner not "help" the patient with verbal or non-verbal cue.
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic hand. If the patient does not respond to
command, the task
should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none,
one or two commands)
What are the results? - ANS 0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or
painful stimulation to
make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and
areflexic.
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, 0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
How to assess best gaze? - ANS Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye movements will be scored, but caloric testing is not
done. If the patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1If a patient has an isolated peripheral nerve paresis (CN III,
IV or VI), score a 1
What are the results? - ANS 0 = Normal.
1 = Partial gaze palsy; gaze is abnormal in one or both eyes,
but forced deviation or total gaze paresis is not present.
2 = Forced deviation, or total gaze
How to assess visual gaze? - ANS Visual fields (upper and lower quadrants) are tested by
confrontation, using finger counting or visual threat, as appropriate.
If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored.
If patient is blind from any cause, score 3.
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
Answers
How to assess Level of Consciousness? - ANS 1a. Deteremine if patient is alert, oriented x4
1b. The patient is asked the month and his/her age.
The answer must be correct - there is no partial credit for being close. Aphasic and stuporous
patients who do not comprehend the questions will score 2. It is important that only the initial
answer be graded and that the examiner not "help" the patient with verbal or non-verbal cue.
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic hand. If the patient does not respond to
command, the task
should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none,
one or two commands)
What are the results? - ANS 0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey,
answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or
painful stimulation to
make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and
areflexic.
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, 0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
How to assess best gaze? - ANS Only horizontal eye movements will be tested.
Voluntary or reflexive (oculocephalic) eye movements will be scored, but caloric testing is not
done. If the patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1If a patient has an isolated peripheral nerve paresis (CN III,
IV or VI), score a 1
What are the results? - ANS 0 = Normal.
1 = Partial gaze palsy; gaze is abnormal in one or both eyes,
but forced deviation or total gaze paresis is not present.
2 = Forced deviation, or total gaze
How to assess visual gaze? - ANS Visual fields (upper and lower quadrants) are tested by
confrontation, using finger counting or visual threat, as appropriate.
If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored.
If patient is blind from any cause, score 3.
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
