NIH STROKE SCALE (NIHSS) – ALL TEST
GROUPS A–F (PATIENTS 1–6): COMPLETE
ANSWER KEY WITH QUESTIONS,
ANSWERS, AND RATIONALES — VERIFIED
AND FULLY UPDATED FOR 2025/2026
Test Group A – Patients 1–6
Patient 1 – 59-year-old male with right-sided weakness and
speech difficulty
1a. Level of Consciousness (LOC):
A) 0 – Alert; keenly responsive
B) 1 – Not alert; arousable by minor stimulation
C) 2 – Not alert; requires repeated stimulation
D) 3 – Unresponsive
Correct Answer: A (0)
Rationale: The patient is awake and alert, responding immediately to the examiner.
No stimulation is required to maintain arousal.
1b. LOC Questions:
A) 0 – Answers both correctly
B) 1 – Answers one correctly
C) 2 – Answers neither correctly
Correct Answer: A (0)
Rationale: The patient correctly states the current month and his age, indicating
intact orientation and no aphasia.
1c. LOC Commands:
A) 0 – Performs both tasks correctly
B) 1 – Performs one task correctly
C) 2 – Performs neither task correctly
,Correct Answer: A (0)
Rationale: He follows both “open/close eyes” and “grip/release hand” commands
without difficulty, showing intact comprehension and motor function.
2. Best Gaze:
A) 0 – Normal
B) 1 – Partial gaze palsy
C) 2 – Forced deviation
Correct Answer: A (0)
Rationale: Extraocular movements are full and conjugate; no gaze palsy or forced
deviation is present.
3. Visual Fields:
A) 0 – No visual loss
B) 1 – Partial hemianopia
C) 2 – Complete hemianopia
D) 3 – Bilateral hemianopia
Correct Answer: A (0)
Rationale: Visual fields are intact in all four quadrants; the patient correctly counts
fingers bilaterally.
4. Facial Palsy:
A) 0 – Normal
B) 1 – Minor paralysis (flattened nasolabial fold)
C) 2 – Partial paralysis (lower face)
D) 3 – Complete paralysis
Correct Answer: B (1)
Rationale: There is flattening of the right nasolabial fold with slight asymmetry on
smiling, consistent with minor facial palsy.
5a. Motor Arm – Left:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: A (0)
Rationale: The left arm maintains its position for the full 10 seconds without drift.
5b. Motor Arm – Right:
A) 0 – No drift
, B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: B (1)
Rationale: The right arm drifts downward but does not reach the bed within 10
seconds, indicating mild weakness.
6a. Motor Leg – Left:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: A (0)
Rationale: The left leg holds position without drift.
6b. Motor Leg – Right:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: B (1)
Rationale: The right leg drifts but does not hit the bed, consistent with mild
weakness.
7. Limb Ataxia:
A) 0 – Absent
B) 1 – Present in one limb
C) 2 – Present in two or more limbs
Correct Answer: A (0)
Rationale: Finger-to-nose and heel-to-shin testing show no ataxia in any limb.
8. Sensory:
A) 0 – Normal
B) 1 – Mild-to-moderate loss
C) 2 – Severe loss
GROUPS A–F (PATIENTS 1–6): COMPLETE
ANSWER KEY WITH QUESTIONS,
ANSWERS, AND RATIONALES — VERIFIED
AND FULLY UPDATED FOR 2025/2026
Test Group A – Patients 1–6
Patient 1 – 59-year-old male with right-sided weakness and
speech difficulty
1a. Level of Consciousness (LOC):
A) 0 – Alert; keenly responsive
B) 1 – Not alert; arousable by minor stimulation
C) 2 – Not alert; requires repeated stimulation
D) 3 – Unresponsive
Correct Answer: A (0)
Rationale: The patient is awake and alert, responding immediately to the examiner.
No stimulation is required to maintain arousal.
1b. LOC Questions:
A) 0 – Answers both correctly
B) 1 – Answers one correctly
C) 2 – Answers neither correctly
Correct Answer: A (0)
Rationale: The patient correctly states the current month and his age, indicating
intact orientation and no aphasia.
1c. LOC Commands:
A) 0 – Performs both tasks correctly
B) 1 – Performs one task correctly
C) 2 – Performs neither task correctly
,Correct Answer: A (0)
Rationale: He follows both “open/close eyes” and “grip/release hand” commands
without difficulty, showing intact comprehension and motor function.
2. Best Gaze:
A) 0 – Normal
B) 1 – Partial gaze palsy
C) 2 – Forced deviation
Correct Answer: A (0)
Rationale: Extraocular movements are full and conjugate; no gaze palsy or forced
deviation is present.
3. Visual Fields:
A) 0 – No visual loss
B) 1 – Partial hemianopia
C) 2 – Complete hemianopia
D) 3 – Bilateral hemianopia
Correct Answer: A (0)
Rationale: Visual fields are intact in all four quadrants; the patient correctly counts
fingers bilaterally.
4. Facial Palsy:
A) 0 – Normal
B) 1 – Minor paralysis (flattened nasolabial fold)
C) 2 – Partial paralysis (lower face)
D) 3 – Complete paralysis
Correct Answer: B (1)
Rationale: There is flattening of the right nasolabial fold with slight asymmetry on
smiling, consistent with minor facial palsy.
5a. Motor Arm – Left:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: A (0)
Rationale: The left arm maintains its position for the full 10 seconds without drift.
5b. Motor Arm – Right:
A) 0 – No drift
, B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: B (1)
Rationale: The right arm drifts downward but does not reach the bed within 10
seconds, indicating mild weakness.
6a. Motor Leg – Left:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: A (0)
Rationale: The left leg holds position without drift.
6b. Motor Leg – Right:
A) 0 – No drift
B) 1 – Drifts but does not hit bed
C) 2 – Some effort against gravity
D) 3 – No effort against gravity
E) 4 – No movement
Correct Answer: B (1)
Rationale: The right leg drifts but does not hit the bed, consistent with mild
weakness.
7. Limb Ataxia:
A) 0 – Absent
B) 1 – Present in one limb
C) 2 – Present in two or more limbs
Correct Answer: A (0)
Rationale: Finger-to-nose and heel-to-shin testing show no ataxia in any limb.
8. Sensory:
A) 0 – Normal
B) 1 – Mild-to-moderate loss
C) 2 – Severe loss
