NIHSS UPDATED SCRIPT 2026 PRACTICE
SOLUTIONS GRADED A+
● A score of <5 on the NIHSS indicates what?. Answer: No stroke
symptoms or minor stroke
● A score of 5-15 on the NIHSS indicates what?. Answer: Moderate
stroke
● A score of 16-20 on the NIHSS indicates what?. Answer: Moderate to
severe
● A score of 21-42 on the NIHSS indicates what?. Answer: Severe
stroke
● 1A. Level of Consciousness (LOC) Scoring. Answer: 0 - Alert; keenly
responsive.
1 - Not Alert; but arousable by minor stimulation to obey, answer, or
respond.
2 - Not Alert; requires repeated stimulation to attend, or is obtunded and
requires strong or painful stimulation to make movements (not
stereotyped).
3 - Responds only with reflex motor or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
, ● 1B. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the questions
are scored 2
Patients unable to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language barrier, or any other
problem not secondary to aphasia are scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
● 1C. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
● 2. Best Gaze NIHSS Scoring. Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
SOLUTIONS GRADED A+
● A score of <5 on the NIHSS indicates what?. Answer: No stroke
symptoms or minor stroke
● A score of 5-15 on the NIHSS indicates what?. Answer: Moderate
stroke
● A score of 16-20 on the NIHSS indicates what?. Answer: Moderate to
severe
● A score of 21-42 on the NIHSS indicates what?. Answer: Severe
stroke
● 1A. Level of Consciousness (LOC) Scoring. Answer: 0 - Alert; keenly
responsive.
1 - Not Alert; but arousable by minor stimulation to obey, answer, or
respond.
2 - Not Alert; requires repeated stimulation to attend, or is obtunded and
requires strong or painful stimulation to make movements (not
stereotyped).
3 - Responds only with reflex motor or autonomic effects, or totally
unresponsive, flaccid, and areflexic.
, ● 1B. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked the month and his/her age. The answer must be correct
Aphasic and stuporous patients who do not comprehend the questions
are scored 2
Patients unable to speak because of endotracheal intubation, orotracheal
trauma, severe dysarthria from any cause, language barrier, or any other
problem not secondary to aphasia are scored 1
0 - Answers both questions correctly
1 - Answers one question correctly
2 - Answers neither question correctly.
● 1C. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked to open and close the eyes and then to grip and release the
nonparetic hand. Substitute another one-step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not
completed due to weakness. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
● 2. Best Gaze NIHSS Scoring. Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
