NIH STROKE SCALE GROUP C PATIENTS 1-6 COMPLETE
SUMMARY 2026/2027 | NIHSS Certification Review Guide |
Verified Scoring & Rationales | Pass Guaranteed - A+ Graded
PATIENT 1: Elderly Male with Left-Sided Weakness and Aphasia
Video Scenario Description: Elderly male patient, alert but with significant
communication difficulties. Opens eyes spontaneously, follows some commands with
right side only. Left face droops, left arm and leg drift to bed. Unable to answer
questions verbally but appears to comprehend partially. Some gaze preference to right.
NIHSS Item Scores:
1a. LOC Responsiveness: 0 [CORRECT]
● Rationale: Patient is alert and responsive, opens eyes spontaneously without
stimulation.
1b. LOC Questions: 2 [CORRECT]
● Rationale: Unable to answer either question (month and age) verbally due to
expressive aphasia. Score 2 for "neither correct" - inability to communicate
answer, not necessarily lack of comprehension.
1c. LOC Commands: 1 [CORRECT]
● Rationale: Performs one command correctly (opens/closes eyes or grips hand on
right side), fails left side due to weakness. Score 1 for "one performed correctly."
2. Best Gaze: 1 [CORRECT]
● Rationale: Gaze is partially abnormal - some gaze preference to right or impaired
left gaze, but not forced deviation. Does not cross midline fully on left.
3. Visual Fields: 0 [CORRECT]
● Rationale: No visual field cut detected. Patient tracks or responds to visual threat
bilaterally.
, 4. Facial Palsy: 2 [CORRECT]
● Rationale: Complete left facial paralysis - upper and lower face affected. No
movement on left side, asymmetry obvious.
5. Motor Arm - Left: 3 [CORRECT]
● Rationale: No effort against gravity. Left arm drifts to bed immediately, no
voluntary movement.
5. Motor Arm - Right: 0 [CORRECT]
● Rationale: Normal strength. Holds arm position against gravity for full 10 seconds
without drift.
6. Motor Leg - Left: 2 [CORRECT]
● Rationale: Some effort against gravity but leg drifts to bed before 5 seconds.
Cannot maintain position.
6. Motor Leg - Right: 0 [CORRECT]
● Rationale: Normal strength. Holds leg position 5 seconds without drift.
7. Limb Ataxia: 0 [CORRECT]
● Rationale: No ataxia observed. Weakness present but not incoordination. Unable
to test left due to weakness, right normal.
8. Sensory: 1 [CORRECT]
● Rationale: Mild-to-moderate sensory loss on left side. Patient feels pinprick but
diminished or asymmetric compared to right.
9. Best Language: 3 [CORRECT]
● Rationale: Severe aphasia - mute or global aphasia. No usable speech or auditory
comprehension evident. Unable to identify items or answer questions.
10. Dysarthria: 1 [CORRECT]
● Rationale: Mild-to-moderate dysarthria. Speech is slurred but can be understood
with difficulty, or patient is mute/aphasic making assessment difficult. Score
based on what can be tested.
11. Extinction/Inattention: 1 [CORRECT]
● Rationale: Inattention to left side during double simultaneous stimulation. Patient
responds to single left-sided stimuli but extinguishes or neglects left when
bilateral stimulation presented.
Total Score: 16 [CORRECT]
PATIENT 2: Middle-Aged Female with Right-Sided Deficits and Neglect
SUMMARY 2026/2027 | NIHSS Certification Review Guide |
Verified Scoring & Rationales | Pass Guaranteed - A+ Graded
PATIENT 1: Elderly Male with Left-Sided Weakness and Aphasia
Video Scenario Description: Elderly male patient, alert but with significant
communication difficulties. Opens eyes spontaneously, follows some commands with
right side only. Left face droops, left arm and leg drift to bed. Unable to answer
questions verbally but appears to comprehend partially. Some gaze preference to right.
NIHSS Item Scores:
1a. LOC Responsiveness: 0 [CORRECT]
● Rationale: Patient is alert and responsive, opens eyes spontaneously without
stimulation.
1b. LOC Questions: 2 [CORRECT]
● Rationale: Unable to answer either question (month and age) verbally due to
expressive aphasia. Score 2 for "neither correct" - inability to communicate
answer, not necessarily lack of comprehension.
1c. LOC Commands: 1 [CORRECT]
● Rationale: Performs one command correctly (opens/closes eyes or grips hand on
right side), fails left side due to weakness. Score 1 for "one performed correctly."
2. Best Gaze: 1 [CORRECT]
● Rationale: Gaze is partially abnormal - some gaze preference to right or impaired
left gaze, but not forced deviation. Does not cross midline fully on left.
3. Visual Fields: 0 [CORRECT]
● Rationale: No visual field cut detected. Patient tracks or responds to visual threat
bilaterally.
, 4. Facial Palsy: 2 [CORRECT]
● Rationale: Complete left facial paralysis - upper and lower face affected. No
movement on left side, asymmetry obvious.
5. Motor Arm - Left: 3 [CORRECT]
● Rationale: No effort against gravity. Left arm drifts to bed immediately, no
voluntary movement.
5. Motor Arm - Right: 0 [CORRECT]
● Rationale: Normal strength. Holds arm position against gravity for full 10 seconds
without drift.
6. Motor Leg - Left: 2 [CORRECT]
● Rationale: Some effort against gravity but leg drifts to bed before 5 seconds.
Cannot maintain position.
6. Motor Leg - Right: 0 [CORRECT]
● Rationale: Normal strength. Holds leg position 5 seconds without drift.
7. Limb Ataxia: 0 [CORRECT]
● Rationale: No ataxia observed. Weakness present but not incoordination. Unable
to test left due to weakness, right normal.
8. Sensory: 1 [CORRECT]
● Rationale: Mild-to-moderate sensory loss on left side. Patient feels pinprick but
diminished or asymmetric compared to right.
9. Best Language: 3 [CORRECT]
● Rationale: Severe aphasia - mute or global aphasia. No usable speech or auditory
comprehension evident. Unable to identify items or answer questions.
10. Dysarthria: 1 [CORRECT]
● Rationale: Mild-to-moderate dysarthria. Speech is slurred but can be understood
with difficulty, or patient is mute/aphasic making assessment difficult. Score
based on what can be tested.
11. Extinction/Inattention: 1 [CORRECT]
● Rationale: Inattention to left side during double simultaneous stimulation. Patient
responds to single left-sided stimuli but extinguishes or neglects left when
bilateral stimulation presented.
Total Score: 16 [CORRECT]
PATIENT 2: Middle-Aged Female with Right-Sided Deficits and Neglect
