ADVENTHEALTH APEX NIH
STROKE SCALE CERTIFICATION
2025/2026 – GROUP B (PATIENTS
1-6) – OFFICIAL TRAINING
MODULE
PATIENT 1 – Moderate Left MCA Stroke with
Aphasia and Right-Sided Neglect
Clinical Presentation: 68-year-old right-handed male, alert, appears
confused. Eyes open spontaneously and track fully to both sides. Pupils
equal and reactive. No facial asymmetry at rest. When asked to show
teeth and raise eyebrows, mild right-sided weakness is noted (able to
move but less than left). Right arm drifts down after 5 seconds but can
sustain against gravity briefly. Right leg shows mild weakness but no
drift. Patient is unable to follow complex commands. When asked his
age and birth month, he answers “thirty-twelve” and “June”
(incorrect—born in August). He is able to close eyes and grip/ungrip on
command. Visual fields tested by confrontation: full to threat bilaterally.
However, during double simultaneous stimulation, ignores right-sided
stimuli. Speech is fluent but filled with semantic paraphasias (“chair”
for “table”); comprehension is impaired. Able to repeat “no ifs, ands, or
buts” with errors (“no yes, ands, or nuts”). No dysarthria. No ataxia.
1a. Level of Consciousness – LOC: Score: 0 *Patient is alert and responsive
throughout the exam.*
1b. LOC Questions: Score: 2 *Patient answers both simple questions
incorrectly due to language impairment (aphasia), per NIHSS scoring rules: “2”
is assigned when patient is unable to answer either question correctly due to
aphasia, not confusion.*
1c. LOC Commands: Score: 0 *Patient correctly performs both one-step
commands (close eyes, grip and release); motor deficits do not interfere with
command execution.*
2. Best Gaze: Score: 0 *Eyes track fully to both sides without limitation; no
gaze palsy or forced deviation observed.*
3. Visual Fields: Score: 0 *Patient responds to visual threat in all quadrants
bilaterally; no field cut detected on confrontation.*
, 4. Facial Palsy: Score: 1 *Mild right lower facial weakness with effort (forehead
and eye closure intact), consistent with “minor paralysis” (score 1) per NIHSS:
incomplete but not full paralysis.*
5a. Motor Arm – Right: Score: 2 *Right arm drifts to bed within 10 seconds
but sustains against gravity initially; meets criteria for “partial paralysis” (score
2).*
5b. Motor Arm – Left: Score: 0 *Left arm sustains full 10 seconds against
gravity with no drift.*
6a. Motor Leg – Right: Score: 1 *Mild right leg weakness but no drift; limb
holds position for full 5 seconds, consistent with “minor drift” (score 1).*
6b. Motor Leg – Left: Score: 0 *Left leg sustains full 5 seconds with no drift.*
7. Limb Ataxia: Score: 0 *Finger-nose-finger and heel-shin tests performed
adequately on both sides; no dysmetria or intention tremor; ataxia not scored in
paretic limbs unless coordination is disproportionately impaired.*
8. Sensory: Score: 0 *Patient responds appropriately to pinprick on face, arms,
and legs bilaterally; no sensory loss detected.*
9. Best Language: Score: 2 *Fluent aphasia with severe comprehension deficit
and paraphasic errors; patient is unable to name, repeat, or follow commands
appropriately—consistent with “severe aphasia” (score 2).*
10. Dysarthria: Score: 0 *Articulation is clear; speech errors are due to
aphasia, not motor speech impairment.*
11. Extinction and Inattention: Score: 1 *Patient consistently ignores
right-sided visual and tactile stimuli during double simultaneous stimulation,
indicating left hemispatial neglect (score 1 for inattention).*
TOTAL NIHSS SCORE for Patient 1: 9
PATIENT 2 – Moderate Right MCA Stroke with
Left Hemiparesis and Ataxia
Clinical Presentation: 55-year-old right-handed female, alert. Gaze
intact. No visual field deficit. Mild left lower facial droop at rest;
improves slightly with effort. Left arm shows significant weakness:
cannot sustain against gravity, drifts immediately. Left leg cannot hold
against gravity. During finger-nose-finger testing, marked dysmetria
and past-pointing on left side. Right side coordinated. Sensation intact
bilaterally. Patient answers orientation questions correctly. Performs
one-step commands correctly. Speech fluent and clear. No language
deficit. On double simultaneous stimulation, responds to all stimuli.
1a. Level of Consciousness – LOC: Score: 0 *Patient is alert and
cooperative.*
1b. LOC Questions: Score: 0 *Answers both questions (age, birth month)
correctly.*
1c. LOC Commands: Score: 0 *Performs both one-step commands accurately.*
2. Best Gaze: Score: 0 *Full conjugate gaze to both sides.*
STROKE SCALE CERTIFICATION
2025/2026 – GROUP B (PATIENTS
1-6) – OFFICIAL TRAINING
MODULE
PATIENT 1 – Moderate Left MCA Stroke with
Aphasia and Right-Sided Neglect
Clinical Presentation: 68-year-old right-handed male, alert, appears
confused. Eyes open spontaneously and track fully to both sides. Pupils
equal and reactive. No facial asymmetry at rest. When asked to show
teeth and raise eyebrows, mild right-sided weakness is noted (able to
move but less than left). Right arm drifts down after 5 seconds but can
sustain against gravity briefly. Right leg shows mild weakness but no
drift. Patient is unable to follow complex commands. When asked his
age and birth month, he answers “thirty-twelve” and “June”
(incorrect—born in August). He is able to close eyes and grip/ungrip on
command. Visual fields tested by confrontation: full to threat bilaterally.
However, during double simultaneous stimulation, ignores right-sided
stimuli. Speech is fluent but filled with semantic paraphasias (“chair”
for “table”); comprehension is impaired. Able to repeat “no ifs, ands, or
buts” with errors (“no yes, ands, or nuts”). No dysarthria. No ataxia.
1a. Level of Consciousness – LOC: Score: 0 *Patient is alert and responsive
throughout the exam.*
1b. LOC Questions: Score: 2 *Patient answers both simple questions
incorrectly due to language impairment (aphasia), per NIHSS scoring rules: “2”
is assigned when patient is unable to answer either question correctly due to
aphasia, not confusion.*
1c. LOC Commands: Score: 0 *Patient correctly performs both one-step
commands (close eyes, grip and release); motor deficits do not interfere with
command execution.*
2. Best Gaze: Score: 0 *Eyes track fully to both sides without limitation; no
gaze palsy or forced deviation observed.*
3. Visual Fields: Score: 0 *Patient responds to visual threat in all quadrants
bilaterally; no field cut detected on confrontation.*
, 4. Facial Palsy: Score: 1 *Mild right lower facial weakness with effort (forehead
and eye closure intact), consistent with “minor paralysis” (score 1) per NIHSS:
incomplete but not full paralysis.*
5a. Motor Arm – Right: Score: 2 *Right arm drifts to bed within 10 seconds
but sustains against gravity initially; meets criteria for “partial paralysis” (score
2).*
5b. Motor Arm – Left: Score: 0 *Left arm sustains full 10 seconds against
gravity with no drift.*
6a. Motor Leg – Right: Score: 1 *Mild right leg weakness but no drift; limb
holds position for full 5 seconds, consistent with “minor drift” (score 1).*
6b. Motor Leg – Left: Score: 0 *Left leg sustains full 5 seconds with no drift.*
7. Limb Ataxia: Score: 0 *Finger-nose-finger and heel-shin tests performed
adequately on both sides; no dysmetria or intention tremor; ataxia not scored in
paretic limbs unless coordination is disproportionately impaired.*
8. Sensory: Score: 0 *Patient responds appropriately to pinprick on face, arms,
and legs bilaterally; no sensory loss detected.*
9. Best Language: Score: 2 *Fluent aphasia with severe comprehension deficit
and paraphasic errors; patient is unable to name, repeat, or follow commands
appropriately—consistent with “severe aphasia” (score 2).*
10. Dysarthria: Score: 0 *Articulation is clear; speech errors are due to
aphasia, not motor speech impairment.*
11. Extinction and Inattention: Score: 1 *Patient consistently ignores
right-sided visual and tactile stimuli during double simultaneous stimulation,
indicating left hemispatial neglect (score 1 for inattention).*
TOTAL NIHSS SCORE for Patient 1: 9
PATIENT 2 – Moderate Right MCA Stroke with
Left Hemiparesis and Ataxia
Clinical Presentation: 55-year-old right-handed female, alert. Gaze
intact. No visual field deficit. Mild left lower facial droop at rest;
improves slightly with effort. Left arm shows significant weakness:
cannot sustain against gravity, drifts immediately. Left leg cannot hold
against gravity. During finger-nose-finger testing, marked dysmetria
and past-pointing on left side. Right side coordinated. Sensation intact
bilaterally. Patient answers orientation questions correctly. Performs
one-step commands correctly. Speech fluent and clear. No language
deficit. On double simultaneous stimulation, responds to all stimuli.
1a. Level of Consciousness – LOC: Score: 0 *Patient is alert and
cooperative.*
1b. LOC Questions: Score: 0 *Answers both questions (age, birth month)
correctly.*
1c. LOC Commands: Score: 0 *Performs both one-step commands accurately.*
2. Best Gaze: Score: 0 *Full conjugate gaze to both sides.*
