2025 NIH Stroke Scale – Group A (Patients 1–6)
,Patient 1 – Mr. James
Clinical Scenario:
Mr. James, a 72-year-old male, was found slumped on the right side of his couch. On
arrival to the ER, he is drowsy, responds only to strong stimuli, and exhibits right-sided
hemiplegia. He opens his eyes only to pain and does not respond to verbal commands.
Speech is slurred and partially incomprehensible.
NIH Stroke Scale Evaluation:
Item Description Score Notes
1a. LOC Not alert; requires 2 Requires painful
repeated stimuli to arouse
stimulation
1b. LOC Questions Cannot answer 2 Unresponsive
month or age
1c. LOC Commands Does not follow 2 No purposeful
commands movement
2. Best Gaze Partial gaze palsy 1 Incomplete eye
movement to one
side
3. Visual Fields Complete 2 Right field deficit
hemianopia
4. Facial Palsy Complete paralysis 2 Right facial droop
(lower face)
5a. Motor Arm (Left) No drift 0 Moves normally
5b. Motor Arm No movement 4 Flaccid
(Right)
6a. Motor Leg (Left) No drift 0 Normal
6b. Motor Leg No movement 4 Flaccid
(Right)
7. Limb Ataxia Not testable NT Paralysis
8. Sensory Severe to total 2 No response to
sensory loss pinprick on right
side
9. Language Severe aphasia 2 Speaks few words
only
10. Dysarthria Severe 2 Slurred,
incomprehensible
11. Profound neglect 2 Ignores right side
Extinction/Inattention completely
🟨 Total NIHSS Score: 27
,Interpretation: Severe stroke. High likelihood of poor prognosis without rapid
intervention.
, Patient 2 – Mrs. Linda
Clinical Scenario:
Mrs. Linda, a 68-year-old woman, presents with sudden onset of slurred speech and right-
sided weakness. She is alert and oriented to person, place, and time. She follows
commands but has some difficulty articulating words. She struggles to raise her right arm
and leg but can move the left side without issue.
NIH Stroke Scale Evaluation:
Item Description Score Notes
1a. LOC Alert 0 Fully alert and
responsive
1b. LOC Questions Answers both 0 Oriented to month
correctly and age
1c. LOC Commands Follows both 0 Raises hand and
commands opens/closes eyes
correctly
2. Best Gaze Normal 0 Smooth movement
of eyes
3. Visual Fields No visual loss 0 Full fields intact
4. Facial Palsy Minor paralysis 1 Slight right facial
droop
5a. Motor Arm (Left) No drift 0 Full strength
5b. Motor Arm Drifts but does not 2 Weak but some
(Right) hit bed effort
6a. Motor Leg (Left) No drift 0 Full strength
6b. Motor Leg Some effort against 2 Drift for <5
(Right) gravity seconds
7. Limb Ataxia None 0 No coordination
problems
8. Sensory Mild loss 1 Slight decreased
sensation to
pinprick on right
side
9. Language Mild aphasia 1 Hesitant but mostly
fluent
10. Dysarthria Mild 1 Slightly slurred but
understandable
11. None 0 Attends to both
Extinction/Inattention sides
🟨 Total NIHSS Score: 8
,Patient 1 – Mr. James
Clinical Scenario:
Mr. James, a 72-year-old male, was found slumped on the right side of his couch. On
arrival to the ER, he is drowsy, responds only to strong stimuli, and exhibits right-sided
hemiplegia. He opens his eyes only to pain and does not respond to verbal commands.
Speech is slurred and partially incomprehensible.
NIH Stroke Scale Evaluation:
Item Description Score Notes
1a. LOC Not alert; requires 2 Requires painful
repeated stimuli to arouse
stimulation
1b. LOC Questions Cannot answer 2 Unresponsive
month or age
1c. LOC Commands Does not follow 2 No purposeful
commands movement
2. Best Gaze Partial gaze palsy 1 Incomplete eye
movement to one
side
3. Visual Fields Complete 2 Right field deficit
hemianopia
4. Facial Palsy Complete paralysis 2 Right facial droop
(lower face)
5a. Motor Arm (Left) No drift 0 Moves normally
5b. Motor Arm No movement 4 Flaccid
(Right)
6a. Motor Leg (Left) No drift 0 Normal
6b. Motor Leg No movement 4 Flaccid
(Right)
7. Limb Ataxia Not testable NT Paralysis
8. Sensory Severe to total 2 No response to
sensory loss pinprick on right
side
9. Language Severe aphasia 2 Speaks few words
only
10. Dysarthria Severe 2 Slurred,
incomprehensible
11. Profound neglect 2 Ignores right side
Extinction/Inattention completely
🟨 Total NIHSS Score: 27
,Interpretation: Severe stroke. High likelihood of poor prognosis without rapid
intervention.
, Patient 2 – Mrs. Linda
Clinical Scenario:
Mrs. Linda, a 68-year-old woman, presents with sudden onset of slurred speech and right-
sided weakness. She is alert and oriented to person, place, and time. She follows
commands but has some difficulty articulating words. She struggles to raise her right arm
and leg but can move the left side without issue.
NIH Stroke Scale Evaluation:
Item Description Score Notes
1a. LOC Alert 0 Fully alert and
responsive
1b. LOC Questions Answers both 0 Oriented to month
correctly and age
1c. LOC Commands Follows both 0 Raises hand and
commands opens/closes eyes
correctly
2. Best Gaze Normal 0 Smooth movement
of eyes
3. Visual Fields No visual loss 0 Full fields intact
4. Facial Palsy Minor paralysis 1 Slight right facial
droop
5a. Motor Arm (Left) No drift 0 Full strength
5b. Motor Arm Drifts but does not 2 Weak but some
(Right) hit bed effort
6a. Motor Leg (Left) No drift 0 Full strength
6b. Motor Leg Some effort against 2 Drift for <5
(Right) gravity seconds
7. Limb Ataxia None 0 No coordination
problems
8. Sensory Mild loss 1 Slight decreased
sensation to
pinprick on right
side
9. Language Mild aphasia 1 Hesitant but mostly
fluent
10. Dysarthria Mild 1 Slightly slurred but
understandable
11. None 0 Attends to both
Extinction/Inattention sides
🟨 Total NIHSS Score: 8
