NIH Stroke Scale | Groups A–F (Patients 1–6)
Complete, Real & Authentic | 2025/2026 Updated Edition | 100% Correct & Solved
Introduction
This comprehensive resource includes all six NIH Stroke Scale testing groups (A through
F). Each group contains six real patient evaluations (Patients 1–6) based on the latest
2025/2026 standards. Every answer is accurate, verified, and reflective of actual clinical
scenarios and expected NIHSS scoring outcomes.
Groups Included:
• Group A – Patients 1 through 6
• Group B – Patients 1 through 6
• Group C – Patients 1 through 6
• Group D – Patients 1 through 6
• Group E – Patients 1 through 6
• Group F – Patients 1 through 6
Each patient case is presented with complete scoring steps and final score based on accurate,
real-exam scoring criteria.
Answer Format
All correct answers are clearly marked in bold and green for fast and efficient clinical
review and exam preparation.
Group A
Patient 1
Scenario: A 65-year-old male presents with sudden left-sided weakness, slurred speech, and
facial droop. He is alert, follows commands, and answers questions appropriately.
• 1a. Level of Consciousness (LOC): Alert, responds fully. 0 (Normal).
• 1b. LOC Questions: Correctly states month and age. 0 (Answers both correctly).
• 1c. LOC Commands: Follows both commands (close eyes, make fist). 0 (Performs
both correctly).
• 2. Best Gaze: Normal eye movements. 0 (Normal).
• 3. Visual Fields: No visual field loss. 0 (Normal).
• 4. Facial Palsy: Right-sided facial droop, asymmetry with smile. 1 (Minor paralysis).
• 5a. Left Arm Motor: Drifts within 10 seconds but does not hit bed. 1 (Drift).
• 5b. Right Arm Motor: Normal strength. 0 (No drift).
, • 6a. Left Leg Motor: Drifts within 5 seconds. 1 (Drift).
• 6b. Right Leg Motor: Normal strength. 0 (No drift).
• 7. Limb Ataxia: No ataxia in finger-to-nose or heel-to-shin tests. 0 (Absent).
• 8. Sensory: Reports decreased sensation on left side. 1 (Mild-to-moderate sensory
loss).
• 9. Best Language: Slurred speech but understandable. 1 (Mild-to-moderate aphasia).
• 10. Dysarthria: Slurred speech, mildly impaired. 1 (Mild-to-moderate dysarthria).
• 11. Extinction/Inattention: No neglect observed. 0 (Normal).
Total Score: 6
Rationale: Scores reflect mild stroke with left-sided weakness, facial droop, sensory
loss, and speech impairment.
Patient 2
Scenario: A 72-year-old female is unresponsive, with no speech or movement on the right
side. She does not follow commands.
• 1a. LOC: Unresponsive to stimuli. 3 (Unresponsive).
• 1b. LOC Questions: Unable to answer. 2 (Answers neither correctly).
• 1c. LOC Commands: Does not follow commands. 2 (Performs neither correctly).
• 2. Best Gaze: Forced deviation to the left. 2 (Forced deviation).
• 3. Visual Fields: Unable to assess due to unresponsiveness. 2 (Complete
hemianopia).
• 4. Facial Palsy: Complete right-sided paralysis. 3 (Complete paralysis).
• 5a. Left Arm Motor: Normal strength. 0 (No drift).
• 5b. Right Arm Motor: No movement. 4 (No movement).
• 6a. Left Leg Motor: Normal strength. 0 (No drift).
• 6b. Right Leg Motor: No movement. 4 (No movement).
• 7. Limb Ataxia: Unable to test due to paralysis. 0 (Untestable).
• 8. Sensory: No response to pinprick on right side. 2 (Severe sensory loss).
• 9. Best Language: No speech output. 3 (Mute/global aphasia).
• 10. Dysarthria: Unable to assess due to no speech. 2 (Severe dysarthria).
• 11. Extinction/Inattention: Ignores right side stimuli. 2 (Profound inattention).
Total Score: 27
, Rationale: Severe stroke with right-sided paralysis, unresponsiveness, and global
deficits.
Patient 3
Scenario: A 58-year-old male with mild confusion, normal strength, and slight word-finding
difficulty.
• 1a. LOC: Alert but mildly confused. 1 (Not fully alert).
• 1b. LOC Questions: Answers one question correctly. 1 (One correct).
• 1c. LOC Commands: Follows both commands. 0 (Performs both correctly).
• 2. Best Gaze: Normal. 0 (Normal).
• 3. Visual Fields: Normal. 0 (Normal).
• 4. Facial Palsy: Normal. 0 (Normal).
• 5a. Left Arm Motor: Normal strength. 0 (No drift).
• 5b. Right Arm Motor: Normal strength. 0 (No drift).
• 6a. Left Leg Motor: Normal strength. 0 (No drift).
• 6b. Right Leg Motor: Normal strength. 0 (No drift).
• 7. Limb Ataxia: No ataxia. 0 (Absent).
• 8. Sensory: Normal sensation. 0 (Normal).
• 9. Best Language: Mild word-finding difficulty. 1 (Mild-to-moderate aphasia).
• 10. Dysarthria: Normal speech. 0 (Normal).
• 11. Extinction/Inattention: Normal. 0 (Normal).
Total Score: 3
Rationale: Mild stroke with minor cognitive and language deficits.
Patient 4
Scenario: A 70-year-old female with right visual field loss and mild left arm weakness.
• 1a. LOC: Alert. 0 (Normal).
• 1b. LOC Questions: Answers both correctly. 0 (Answers both correctly).
• 1c. LOC Commands: Follows both commands. 0 (Performs both correctly).
• 2. Best Gaze: Normal. 0 (Normal).
• 3. Visual Fields: Right homonymous hemianopia. 2 (Complete hemianopia).
Complete, Real & Authentic | 2025/2026 Updated Edition | 100% Correct & Solved
Introduction
This comprehensive resource includes all six NIH Stroke Scale testing groups (A through
F). Each group contains six real patient evaluations (Patients 1–6) based on the latest
2025/2026 standards. Every answer is accurate, verified, and reflective of actual clinical
scenarios and expected NIHSS scoring outcomes.
Groups Included:
• Group A – Patients 1 through 6
• Group B – Patients 1 through 6
• Group C – Patients 1 through 6
• Group D – Patients 1 through 6
• Group E – Patients 1 through 6
• Group F – Patients 1 through 6
Each patient case is presented with complete scoring steps and final score based on accurate,
real-exam scoring criteria.
Answer Format
All correct answers are clearly marked in bold and green for fast and efficient clinical
review and exam preparation.
Group A
Patient 1
Scenario: A 65-year-old male presents with sudden left-sided weakness, slurred speech, and
facial droop. He is alert, follows commands, and answers questions appropriately.
• 1a. Level of Consciousness (LOC): Alert, responds fully. 0 (Normal).
• 1b. LOC Questions: Correctly states month and age. 0 (Answers both correctly).
• 1c. LOC Commands: Follows both commands (close eyes, make fist). 0 (Performs
both correctly).
• 2. Best Gaze: Normal eye movements. 0 (Normal).
• 3. Visual Fields: No visual field loss. 0 (Normal).
• 4. Facial Palsy: Right-sided facial droop, asymmetry with smile. 1 (Minor paralysis).
• 5a. Left Arm Motor: Drifts within 10 seconds but does not hit bed. 1 (Drift).
• 5b. Right Arm Motor: Normal strength. 0 (No drift).
, • 6a. Left Leg Motor: Drifts within 5 seconds. 1 (Drift).
• 6b. Right Leg Motor: Normal strength. 0 (No drift).
• 7. Limb Ataxia: No ataxia in finger-to-nose or heel-to-shin tests. 0 (Absent).
• 8. Sensory: Reports decreased sensation on left side. 1 (Mild-to-moderate sensory
loss).
• 9. Best Language: Slurred speech but understandable. 1 (Mild-to-moderate aphasia).
• 10. Dysarthria: Slurred speech, mildly impaired. 1 (Mild-to-moderate dysarthria).
• 11. Extinction/Inattention: No neglect observed. 0 (Normal).
Total Score: 6
Rationale: Scores reflect mild stroke with left-sided weakness, facial droop, sensory
loss, and speech impairment.
Patient 2
Scenario: A 72-year-old female is unresponsive, with no speech or movement on the right
side. She does not follow commands.
• 1a. LOC: Unresponsive to stimuli. 3 (Unresponsive).
• 1b. LOC Questions: Unable to answer. 2 (Answers neither correctly).
• 1c. LOC Commands: Does not follow commands. 2 (Performs neither correctly).
• 2. Best Gaze: Forced deviation to the left. 2 (Forced deviation).
• 3. Visual Fields: Unable to assess due to unresponsiveness. 2 (Complete
hemianopia).
• 4. Facial Palsy: Complete right-sided paralysis. 3 (Complete paralysis).
• 5a. Left Arm Motor: Normal strength. 0 (No drift).
• 5b. Right Arm Motor: No movement. 4 (No movement).
• 6a. Left Leg Motor: Normal strength. 0 (No drift).
• 6b. Right Leg Motor: No movement. 4 (No movement).
• 7. Limb Ataxia: Unable to test due to paralysis. 0 (Untestable).
• 8. Sensory: No response to pinprick on right side. 2 (Severe sensory loss).
• 9. Best Language: No speech output. 3 (Mute/global aphasia).
• 10. Dysarthria: Unable to assess due to no speech. 2 (Severe dysarthria).
• 11. Extinction/Inattention: Ignores right side stimuli. 2 (Profound inattention).
Total Score: 27
, Rationale: Severe stroke with right-sided paralysis, unresponsiveness, and global
deficits.
Patient 3
Scenario: A 58-year-old male with mild confusion, normal strength, and slight word-finding
difficulty.
• 1a. LOC: Alert but mildly confused. 1 (Not fully alert).
• 1b. LOC Questions: Answers one question correctly. 1 (One correct).
• 1c. LOC Commands: Follows both commands. 0 (Performs both correctly).
• 2. Best Gaze: Normal. 0 (Normal).
• 3. Visual Fields: Normal. 0 (Normal).
• 4. Facial Palsy: Normal. 0 (Normal).
• 5a. Left Arm Motor: Normal strength. 0 (No drift).
• 5b. Right Arm Motor: Normal strength. 0 (No drift).
• 6a. Left Leg Motor: Normal strength. 0 (No drift).
• 6b. Right Leg Motor: Normal strength. 0 (No drift).
• 7. Limb Ataxia: No ataxia. 0 (Absent).
• 8. Sensory: Normal sensation. 0 (Normal).
• 9. Best Language: Mild word-finding difficulty. 1 (Mild-to-moderate aphasia).
• 10. Dysarthria: Normal speech. 0 (Normal).
• 11. Extinction/Inattention: Normal. 0 (Normal).
Total Score: 3
Rationale: Mild stroke with minor cognitive and language deficits.
Patient 4
Scenario: A 70-year-old female with right visual field loss and mild left arm weakness.
• 1a. LOC: Alert. 0 (Normal).
• 1b. LOC Questions: Answers both correctly. 0 (Answers both correctly).
• 1c. LOC Commands: Follows both commands. 0 (Performs both correctly).
• 2. Best Gaze: Normal. 0 (Normal).
• 3. Visual Fields: Right homonymous hemianopia. 2 (Complete hemianopia).
