NIH Stroke Scale (NIHSS) Practice Test: Complete Patient
Cases 1–6 With Scoring Guide and Answer Explanations
2026/2027 | Instant Pdf Download
INTRO
Practice the NIH Stroke Scale (NIHSS) with six original stroke assessment cases covering all major scoring
categories, including consciousness, motor deficits, language, sensory changes, dysarthria, and neglect.
Coverage:
NIHSS assessment practice cases
Step-by-step scoring breakdown
Stroke severity interpretation
Neurological deficit evaluation
LOC, gaze, vision, motor, sensory, and language assessment
Dysarthria and extinction/inattention scoring
Clinical reasoning for stroke assessment preparation
NIHSS Practice Cases – Patient 1
Patient 1 Scenario
A 68-year-old patient arrives 90 minutes after sudden onset of left-sided weakness and
difficulty speaking. The patient is awake and able to maintain attention. The examiner notes
the following findings:
Patient correctly states their age but cannot state the current month.
Patient follows both simple commands correctly.
Eyes are deviated slightly to the right but can be moved past midline with effort.
Patient has complete left facial weakness involving the lower face.
Left arm falls immediately after being lifted and cannot resist gravity.
Left leg shows some effort against gravity but falls before 5 seconds.
No limb ataxia is present.
, Patient reports decreased sensation on the left side.
Patient can identify objects but has difficulty forming complete sentences.
Speech is understandable but mildly slurred.
Patient demonstrates mild neglect of the left side.
NIHSS Scoring
NIHSS Item Score Explanation
1a. Level of
0 Patient is alert and responsive.
Consciousness
One question (month) is incorrect while the other is
1b. LOC Questions 1
correct.
1c. LOC Commands 0 Both commands are performed correctly.
Partial gaze limitation is present but not forced
2. Best Gaze 1
deviation.
3. Visual Fields 0 No visual field loss described.
4. Facial Palsy 2 Complete lower facial paralysis is present.
5a. Left Arm Motor 3 No effort against gravity; arm falls immediately.
5b. Right Arm Motor 0 Normal movement.
Some effort against gravity but cannot maintain
6a. Left Leg Motor 2
position.
6b. Right Leg Motor 0 Normal movement.
7. Limb Ataxia 0 No coordination abnormality.
8. Sensory 1 Mild-to-moderate sensory loss.
9. Language 1 Mild aphasia with difficulty expressing sentences.
10. Dysarthria 1 Mild slurring but understandable.
Cases 1–6 With Scoring Guide and Answer Explanations
2026/2027 | Instant Pdf Download
INTRO
Practice the NIH Stroke Scale (NIHSS) with six original stroke assessment cases covering all major scoring
categories, including consciousness, motor deficits, language, sensory changes, dysarthria, and neglect.
Coverage:
NIHSS assessment practice cases
Step-by-step scoring breakdown
Stroke severity interpretation
Neurological deficit evaluation
LOC, gaze, vision, motor, sensory, and language assessment
Dysarthria and extinction/inattention scoring
Clinical reasoning for stroke assessment preparation
NIHSS Practice Cases – Patient 1
Patient 1 Scenario
A 68-year-old patient arrives 90 minutes after sudden onset of left-sided weakness and
difficulty speaking. The patient is awake and able to maintain attention. The examiner notes
the following findings:
Patient correctly states their age but cannot state the current month.
Patient follows both simple commands correctly.
Eyes are deviated slightly to the right but can be moved past midline with effort.
Patient has complete left facial weakness involving the lower face.
Left arm falls immediately after being lifted and cannot resist gravity.
Left leg shows some effort against gravity but falls before 5 seconds.
No limb ataxia is present.
, Patient reports decreased sensation on the left side.
Patient can identify objects but has difficulty forming complete sentences.
Speech is understandable but mildly slurred.
Patient demonstrates mild neglect of the left side.
NIHSS Scoring
NIHSS Item Score Explanation
1a. Level of
0 Patient is alert and responsive.
Consciousness
One question (month) is incorrect while the other is
1b. LOC Questions 1
correct.
1c. LOC Commands 0 Both commands are performed correctly.
Partial gaze limitation is present but not forced
2. Best Gaze 1
deviation.
3. Visual Fields 0 No visual field loss described.
4. Facial Palsy 2 Complete lower facial paralysis is present.
5a. Left Arm Motor 3 No effort against gravity; arm falls immediately.
5b. Right Arm Motor 0 Normal movement.
Some effort against gravity but cannot maintain
6a. Left Leg Motor 2
position.
6b. Right Leg Motor 0 Normal movement.
7. Limb Ataxia 0 No coordination abnormality.
8. Sensory 1 Mild-to-moderate sensory loss.
9. Language 1 Mild aphasia with difficulty expressing sentences.
10. Dysarthria 1 Mild slurring but understandable.
