NIH STROKE SCALE GROUP F PATIENTS 1-6 COMPLETE
SUMMARY 2026/2027 | Verified NIHSS Answers & Scoring |
Certification Exam Prep | Pass Guaranteed - A+ Graded
PATIENT 1: Elderly Male, Acute Left MCA Stroke
Video Scenario Description: 78-year-old male found down at home. Awake but lethargic.
Right-sided weakness noted by EMS. Slurred speech. Follows some commands
intermittently. Right gaze preference. Right facial droop.
NIHSS Item Scores:
1a. LOC Responsiveness: 1 [CORRECT]
● Rationale: Patient is not alert but arouses with minor stimulation (voice/touch).
Opens eyes and responds to questions when prompted but drifts back to sleep.
Not fully alert (0), not requiring repeated stimulation (2), nor unresponsive/reflex
only (3).
1b. LOC Questions (Month, Age): 2 [CORRECT]
● Rationale: Patient answers neither question correctly. Attempts to speak but
responses are unintelligible/incorrect. Score 2 for incorrect on both. If aphasic,
automatic score 2.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 2 [CORRECT]
● Rationale: Patient unable to perform either command correctly. Right arm
weakness prevents grip/release; eye opening inconsistent with command versus
spontaneous. Score 2 for incorrect on both commands.
2. Best Gaze: 1 [CORRECT]
, ● Rationale: Right gaze preference present—eyes deviated to right at rest.
Correctable with oculocephalic maneuver (doll's eyes) or calorics. Partial gaze
palsy (1), not forced deviation (2) nor normal (0).
3. Visual Fields: 1 [CORRECT]
● Rationale: Partial right hemianopia on confrontation testing. Patient does not
consistently see finger counting on right side in both eyes. Not complete
hemianopia (2) nor normal (0).
4. Facial Palsy: 2 [CORRECT]
● Rationale: Complete right facial paralysis—no movement of frontalis or
orbicularis oculi on right. Asymmetry obvious at rest and with stimulation. Partial
(1) would show some movement; normal (0) symmetric.
5. Motor Arm - Left: 0 [CORRECT]
● Rationale: Left arm no drift for full 10 seconds. Holds at 90° (or 45° if supine)
without assistance. Normal strength.
5. Motor Arm - Right: 3 [CORRECT]
● Rationale: Right arm no effort against gravity—limb falls immediately or cannot
be positioned. Complete paralysis of right arm. Score 3 (no movement) versus
drift (1), cannot resist gravity (2).
6. Motor Leg - Left: 0 [CORRECT]
● Rationale: Left leg no drift for full 5 seconds. Holds at 30° without assistance.
Normal strength.
6. Motor Leg - Right: 2 [CORRECT]
● Rationale: Right leg cannot resist gravity—falls to bed immediately when lifted.
Some effort present but insufficient to maintain position. Score 2 versus drift (1)
or no effort (3).
7. Limb Ataxia: 0 [CORRECT]
, ● Rationale: No ataxia present on finger-to-nose and heel-to-shin testing. Right limb
weakness is paralysis, not incoordination. Ataxia only scored if present and not
due to weakness.
8. Sensory: 1 [CORRECT]
● Rationale: Partial sensory loss on right side—patient feels pinprick but duller/less
sharp compared to left. Not completely absent (2) nor normal symmetric (0).
9. Best Language: 2 [CORRECT]
● Rationale: Severe aphasia—patient unable to name objects, follow commands, or
communicate meaningfully. Fragmented words without comprehensible speech.
Global or expressive aphasia present.
10. Dysarthria: 1 [CORRECT]
● Rationale: Mild to moderate dysarthria—slurred speech but some words
intelligible. Patient attempts speech with articulation difficulty. Not absent (0) nor
unintelligible/aphasic (2—if aphasic, score 9/UN).
11. Extinction/Inattention: 1 [CORRECT]
● Rationale: Inattention to right side on double simultaneous stimulation—patient
notices left stimuli when presented alone but extinguishes right when both
presented together. Not profound neglect (2) nor normal (0).
Total Score: 18 [CORRECT]
Interpretation: Moderate to severe stroke; candidate for acute interventions.
PATIENT 2: Middle-Aged Female, Acute Right Hemisphere Stroke
Video Scenario Description: 62-year-old female with sudden left-sided neglect. Alert and
cooperative. Denies any problems ("I'm fine"). Left-sided visual extinction. Left arm
weakness with drift.
SUMMARY 2026/2027 | Verified NIHSS Answers & Scoring |
Certification Exam Prep | Pass Guaranteed - A+ Graded
PATIENT 1: Elderly Male, Acute Left MCA Stroke
Video Scenario Description: 78-year-old male found down at home. Awake but lethargic.
Right-sided weakness noted by EMS. Slurred speech. Follows some commands
intermittently. Right gaze preference. Right facial droop.
NIHSS Item Scores:
1a. LOC Responsiveness: 1 [CORRECT]
● Rationale: Patient is not alert but arouses with minor stimulation (voice/touch).
Opens eyes and responds to questions when prompted but drifts back to sleep.
Not fully alert (0), not requiring repeated stimulation (2), nor unresponsive/reflex
only (3).
1b. LOC Questions (Month, Age): 2 [CORRECT]
● Rationale: Patient answers neither question correctly. Attempts to speak but
responses are unintelligible/incorrect. Score 2 for incorrect on both. If aphasic,
automatic score 2.
1c. LOC Commands (Open/Close Eyes, Grip/Release): 2 [CORRECT]
● Rationale: Patient unable to perform either command correctly. Right arm
weakness prevents grip/release; eye opening inconsistent with command versus
spontaneous. Score 2 for incorrect on both commands.
2. Best Gaze: 1 [CORRECT]
, ● Rationale: Right gaze preference present—eyes deviated to right at rest.
Correctable with oculocephalic maneuver (doll's eyes) or calorics. Partial gaze
palsy (1), not forced deviation (2) nor normal (0).
3. Visual Fields: 1 [CORRECT]
● Rationale: Partial right hemianopia on confrontation testing. Patient does not
consistently see finger counting on right side in both eyes. Not complete
hemianopia (2) nor normal (0).
4. Facial Palsy: 2 [CORRECT]
● Rationale: Complete right facial paralysis—no movement of frontalis or
orbicularis oculi on right. Asymmetry obvious at rest and with stimulation. Partial
(1) would show some movement; normal (0) symmetric.
5. Motor Arm - Left: 0 [CORRECT]
● Rationale: Left arm no drift for full 10 seconds. Holds at 90° (or 45° if supine)
without assistance. Normal strength.
5. Motor Arm - Right: 3 [CORRECT]
● Rationale: Right arm no effort against gravity—limb falls immediately or cannot
be positioned. Complete paralysis of right arm. Score 3 (no movement) versus
drift (1), cannot resist gravity (2).
6. Motor Leg - Left: 0 [CORRECT]
● Rationale: Left leg no drift for full 5 seconds. Holds at 30° without assistance.
Normal strength.
6. Motor Leg - Right: 2 [CORRECT]
● Rationale: Right leg cannot resist gravity—falls to bed immediately when lifted.
Some effort present but insufficient to maintain position. Score 2 versus drift (1)
or no effort (3).
7. Limb Ataxia: 0 [CORRECT]
, ● Rationale: No ataxia present on finger-to-nose and heel-to-shin testing. Right limb
weakness is paralysis, not incoordination. Ataxia only scored if present and not
due to weakness.
8. Sensory: 1 [CORRECT]
● Rationale: Partial sensory loss on right side—patient feels pinprick but duller/less
sharp compared to left. Not completely absent (2) nor normal symmetric (0).
9. Best Language: 2 [CORRECT]
● Rationale: Severe aphasia—patient unable to name objects, follow commands, or
communicate meaningfully. Fragmented words without comprehensible speech.
Global or expressive aphasia present.
10. Dysarthria: 1 [CORRECT]
● Rationale: Mild to moderate dysarthria—slurred speech but some words
intelligible. Patient attempts speech with articulation difficulty. Not absent (0) nor
unintelligible/aphasic (2—if aphasic, score 9/UN).
11. Extinction/Inattention: 1 [CORRECT]
● Rationale: Inattention to right side on double simultaneous stimulation—patient
notices left stimuli when presented alone but extinguishes right when both
presented together. Not profound neglect (2) nor normal (0).
Total Score: 18 [CORRECT]
Interpretation: Moderate to severe stroke; candidate for acute interventions.
PATIENT 2: Middle-Aged Female, Acute Right Hemisphere Stroke
Video Scenario Description: 62-year-old female with sudden left-sided neglect. Alert and
cooperative. Denies any problems ("I'm fine"). Left-sided visual extinction. Left arm
weakness with drift.
