NIH STROKE SCALE EXAM UPDATED
QUESTIONS AND VERIFIED ANSWERS 2026-2027
1. Score for large strokes: > 10
(however, if it is a brainstem stroke it can have a low score and still be a large stroke)
2. Lowest score
Highest score: Lowest score is 0
Highest score is 42
3. Components of *Eyes*: Gaze
- voluntary gaze direction (non-comatose)
- vestibule-ocular reflex (comatose)
Visual fields
- confrontation, all 4 quadrants (non-comatose)
- threat (comatose)
4. Components of *LOC*: Arousal
Questions
- name
STUDY ONLINE AT HTTPS://QUIZLET.COM/_HWK48S
- month
Commands
- open eyes
- grip/release
5. Components of *Face*: Facial droop
- smile & eyebrow raise (normal LOC / drowsy)
- grimace w/ pain (obtunded)
6. Components of *Motor Strength*: Arm strength
- raise arms 45° (supine)
- raise arms 90° (sitting)
Leg strength
- raise legs 30° (always test supine)
1/8
, NIH STROKE SCALE EXAM UPDATED
QUESTIONS AND VERIFIED ANSWERS 2026-2027
7. Components of *Limb Ataxia*: Finger’nose & Heel’shin
8. Components of *Sensory*: Pinprick
- all 4 limbs; up to elbow
9. Components of *Language*: Aphasia
- describe picture; name objects (w/ adequate vision)
- describe large objects in room or ask questions (w/ inadequate vision)
10. Components of *Dysarthria*: Character of speech
- read sentences / words (w/ adequate vision)
- repeat "methodist episcopal" (w/ inadequate vision)
- listen for slurred, garbled, incoherent
11. Components of *Extinction/Inattention*: Vision extinction:
- look at wiggling hand
Sensory test
- upper & lower extensors
12. Special Cases: 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. STUDY ONLINE AT HTTPS://QUIZLET.COM/_HWK48S
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 Ataxia only scored if
positive; comatose or paralyzed get a 0
Intubated Pt should write to complete language (aphasia) portion when possible and get "UN" for dysarthria (motor speech) portion
2/8
QUESTIONS AND VERIFIED ANSWERS 2026-2027
1. Score for large strokes: > 10
(however, if it is a brainstem stroke it can have a low score and still be a large stroke)
2. Lowest score
Highest score: Lowest score is 0
Highest score is 42
3. Components of *Eyes*: Gaze
- voluntary gaze direction (non-comatose)
- vestibule-ocular reflex (comatose)
Visual fields
- confrontation, all 4 quadrants (non-comatose)
- threat (comatose)
4. Components of *LOC*: Arousal
Questions
- name
STUDY ONLINE AT HTTPS://QUIZLET.COM/_HWK48S
- month
Commands
- open eyes
- grip/release
5. Components of *Face*: Facial droop
- smile & eyebrow raise (normal LOC / drowsy)
- grimace w/ pain (obtunded)
6. Components of *Motor Strength*: Arm strength
- raise arms 45° (supine)
- raise arms 90° (sitting)
Leg strength
- raise legs 30° (always test supine)
1/8
, NIH STROKE SCALE EXAM UPDATED
QUESTIONS AND VERIFIED ANSWERS 2026-2027
7. Components of *Limb Ataxia*: Finger’nose & Heel’shin
8. Components of *Sensory*: Pinprick
- all 4 limbs; up to elbow
9. Components of *Language*: Aphasia
- describe picture; name objects (w/ adequate vision)
- describe large objects in room or ask questions (w/ inadequate vision)
10. Components of *Dysarthria*: Character of speech
- read sentences / words (w/ adequate vision)
- repeat "methodist episcopal" (w/ inadequate vision)
- listen for slurred, garbled, incoherent
11. Components of *Extinction/Inattention*: Vision extinction:
- look at wiggling hand
Sensory test
- upper & lower extensors
12. Special Cases: 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. STUDY ONLINE AT HTTPS://QUIZLET.COM/_HWK48S
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 Ataxia only scored if
positive; comatose or paralyzed get a 0
Intubated Pt should write to complete language (aphasia) portion when possible and get "UN" for dysarthria (motor speech) portion
2/8
