PASSPOINT PRO
NIH STROKE SCALE STUDY SERIES
NIHSS Groups A-F Clinical Case Practice
Workbook
36 original patient scenarios organized into Groups A-F with step-by-
step scoring and totals.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-02
,PASSPOINT PRO NIHSS 36-Case Workbook
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
How the 36-case workbook is organized
The workbook is divided into six study blocks labeled A-F, with six original patients in each block. The labels are
organizational only; these are not the proprietary patients or answer keys from the AHA certification videos.
NIHSS exam-prep and scoring practice Page 2
,PASSPOINT PRO NIHSS 36-Case Workbook
Practice Group A - Patients 1-6
Case 1 - Group A, Patient 1
Scenario: A patient arrives for a standardized NIHSS assessment. Score each item from the findings below, then calculate the
total before checking the worked answer.
1a Level of Consciousness: Alert and readily responsive.
1b LOC Questions: Both orientation questions are answered correctly.
1c LOC Commands: Both simple commands are performed correctly.
2 Best Gaze: Horizontal eye movements are normal.
3 Visual Fields: Partial hemianopia or consistent visual field asymmetry is present.
4 Facial Palsy: Minor facial weakness such as a flattened nasolabial fold or asymmetry on smiling.
5L Motor Arm - Left: Left arm drifts but does not hit the support before 10 seconds.
5R Motor Arm - Right: Right arm holds the required position without drift.
6L Motor Leg - Left: Left leg drifts but does not hit the bed before 5 seconds.
6R Motor Leg - Right: Right leg holds the required position without drift.
7 Limb Ataxia: No limb ataxia is demonstrated, or weakness prevents valid demonstration of ataxia.
8 Sensory: There is severe-to-total sensory loss in the relevant distribution.
9 Best Language: Mild-to-moderate aphasia is present, but communication remains meaningfully possible.
10 Dysarthria: Mild-to-moderate dysarthria is present but words remain understandable.
11 Extinction/Inattention: Extinction or inattention is demonstrated in one sensory modality.
Your task: Record all 15 component scores and the total NIHSS.
Item Score
1a 0
1b 0
1c 0
2 0
3 1
4 1
5L 1
5R 0
6L 1
6R 0
7 0
8 2
9 1
10 1
11 1
TOTAL 9
Worked rationale: The total is the sum of the scored components: 3=1, 4=1, 5L=1, 6L=1, 8=2, 9=1, 10=1, 11=1, giving 9. Each item is
scored independently from the observed performance, so a dramatic finding in one domain should not automatically change another
domain. Review any mismatch by returning to the item definition, not by trying to make the total fit an expected stroke pattern.
NIHSS exam-prep and scoring practice Page 3
, PASSPOINT PRO NIHSS 36-Case Workbook
Case 2 - Group A, Patient 2
Scenario: A patient arrives for a standardized NIHSS assessment. Score each item from the findings below, then calculate the
total before checking the worked answer.
1a Level of Consciousness: Alert and readily responsive.
1b LOC Questions: Both orientation questions are answered correctly.
1c LOC Commands: Both simple commands are performed correctly.
2 Best Gaze: Horizontal eye movements are normal.
3 Visual Fields: Bilateral hemianopia, including cortical blindness, is present.
4 Facial Palsy: Facial movement is symmetric.
5L Motor Arm - Left: Left arm holds the required position without drift.
5R Motor Arm - Right: Right arm holds the required position without drift.
6L Motor Leg - Left: Left leg holds the required position without drift.
6R Motor Leg - Right: Right leg holds the required position without drift.
7 Limb Ataxia: Ataxia is clearly present in one testable limb.
8 Sensory: There is mild-to-moderate sensory loss, but the patient remains aware of being touched.
9 Best Language: Mild-to-moderate aphasia is present, but communication remains meaningfully possible.
10 Dysarthria: Speech articulation is normal.
11 Extinction/Inattention: No neglect or extinction is demonstrated.
Your task: Record all 15 component scores and the total NIHSS.
Item Score
1a 0
1b 0
1c 0
2 0
3 3
4 0
5L 0
5R 0
6L 0
6R 0
7 1
8 1
9 1
10 0
11 0
TOTAL 6
Worked rationale: The total is the sum of the scored components: 3=3, 7=1, 8=1, 9=1, giving 6. Each item is scored independently from
the observed performance, so a dramatic finding in one domain should not automatically change another domain. Review any mismatch by
returning to the item definition, not by trying to make the total fit an expected stroke pattern.
Case 3 - Group A, Patient 3
NIHSS exam-prep and scoring practice Page 4
NIH STROKE SCALE STUDY SERIES
NIHSS Groups A-F Clinical Case Practice
Workbook
36 original patient scenarios organized into Groups A-F with step-by-
step scoring and totals.
ORIGINAL PRACTICE MATERIAL
• Scoring guidance and exam technique
• Clinical application cases and scoring drills
• Detailed answers and rationales
PPP-NIHSS-02
,PASSPOINT PRO NIHSS 36-Case Workbook
How to Use This Resource
This series uses original scenarios and questions to practice NIH Stroke Scale administration and scoring. It does not
reproduce proprietary certification test videos, patient identities, or official test-group answer keys. Use the current
NINDS NIH Stroke Scale instructions and your organization's approved training process for clinical competency.
Core administration principles
• Administer items in the standardized order and record the score for each item as it is performed.
• Score observed performance rather than presumed ability, and avoid returning to earlier items simply to improve consistency
with later findings.
• Use the standardized task and timing for each item; arm drift is observed over 10 seconds and leg drift over 5 seconds.
• Separate language impairment (aphasia), articulation impairment (dysarthria), primary sensory/visual loss, and
extinction/inattention.
• The total NIHSS can range from 0 to 42. The total is useful for quantifying neurologic deficit, but individual item patterns still
matter.
How the 36-case workbook is organized
The workbook is divided into six study blocks labeled A-F, with six original patients in each block. The labels are
organizational only; these are not the proprietary patients or answer keys from the AHA certification videos.
NIHSS exam-prep and scoring practice Page 2
,PASSPOINT PRO NIHSS 36-Case Workbook
Practice Group A - Patients 1-6
Case 1 - Group A, Patient 1
Scenario: A patient arrives for a standardized NIHSS assessment. Score each item from the findings below, then calculate the
total before checking the worked answer.
1a Level of Consciousness: Alert and readily responsive.
1b LOC Questions: Both orientation questions are answered correctly.
1c LOC Commands: Both simple commands are performed correctly.
2 Best Gaze: Horizontal eye movements are normal.
3 Visual Fields: Partial hemianopia or consistent visual field asymmetry is present.
4 Facial Palsy: Minor facial weakness such as a flattened nasolabial fold or asymmetry on smiling.
5L Motor Arm - Left: Left arm drifts but does not hit the support before 10 seconds.
5R Motor Arm - Right: Right arm holds the required position without drift.
6L Motor Leg - Left: Left leg drifts but does not hit the bed before 5 seconds.
6R Motor Leg - Right: Right leg holds the required position without drift.
7 Limb Ataxia: No limb ataxia is demonstrated, or weakness prevents valid demonstration of ataxia.
8 Sensory: There is severe-to-total sensory loss in the relevant distribution.
9 Best Language: Mild-to-moderate aphasia is present, but communication remains meaningfully possible.
10 Dysarthria: Mild-to-moderate dysarthria is present but words remain understandable.
11 Extinction/Inattention: Extinction or inattention is demonstrated in one sensory modality.
Your task: Record all 15 component scores and the total NIHSS.
Item Score
1a 0
1b 0
1c 0
2 0
3 1
4 1
5L 1
5R 0
6L 1
6R 0
7 0
8 2
9 1
10 1
11 1
TOTAL 9
Worked rationale: The total is the sum of the scored components: 3=1, 4=1, 5L=1, 6L=1, 8=2, 9=1, 10=1, 11=1, giving 9. Each item is
scored independently from the observed performance, so a dramatic finding in one domain should not automatically change another
domain. Review any mismatch by returning to the item definition, not by trying to make the total fit an expected stroke pattern.
NIHSS exam-prep and scoring practice Page 3
, PASSPOINT PRO NIHSS 36-Case Workbook
Case 2 - Group A, Patient 2
Scenario: A patient arrives for a standardized NIHSS assessment. Score each item from the findings below, then calculate the
total before checking the worked answer.
1a Level of Consciousness: Alert and readily responsive.
1b LOC Questions: Both orientation questions are answered correctly.
1c LOC Commands: Both simple commands are performed correctly.
2 Best Gaze: Horizontal eye movements are normal.
3 Visual Fields: Bilateral hemianopia, including cortical blindness, is present.
4 Facial Palsy: Facial movement is symmetric.
5L Motor Arm - Left: Left arm holds the required position without drift.
5R Motor Arm - Right: Right arm holds the required position without drift.
6L Motor Leg - Left: Left leg holds the required position without drift.
6R Motor Leg - Right: Right leg holds the required position without drift.
7 Limb Ataxia: Ataxia is clearly present in one testable limb.
8 Sensory: There is mild-to-moderate sensory loss, but the patient remains aware of being touched.
9 Best Language: Mild-to-moderate aphasia is present, but communication remains meaningfully possible.
10 Dysarthria: Speech articulation is normal.
11 Extinction/Inattention: No neglect or extinction is demonstrated.
Your task: Record all 15 component scores and the total NIHSS.
Item Score
1a 0
1b 0
1c 0
2 0
3 3
4 0
5L 0
5R 0
6L 0
6R 0
7 1
8 1
9 1
10 0
11 0
TOTAL 6
Worked rationale: The total is the sum of the scored components: 3=3, 7=1, 8=1, 9=1, giving 6. Each item is scored independently from
the observed performance, so a dramatic finding in one domain should not automatically change another domain. Review any mismatch by
returning to the item definition, not by trying to make the total fit an expected stroke pattern.
Case 3 - Group A, Patient 3
NIHSS exam-prep and scoring practice Page 4
