NIH Stroke Scale Group E

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NIH Stroke Scale Group E
1. (1a) Level of consciousness: The recorded score is 0. Which description matches this finding?
A. Somnolent but arousable to voice
B. Requires repeated stimulation to arouse
C. Unresponsive to painful stimuli
D. ✔ Alert, keenly responsive and awake.
Rationale: NIHSS 1a = 0 means patient is fully alert with no decreased level of consciousness.

2. (1b) Orientation questions (time & age): Score 0. Which best describes that score?
A. Answers neither question correctly
B. Answers one of two correctly
C. ✔ Answers both orientation questions correctly.
D. Not testable due to language barrier
Rationale: Score 0 = both orientation questions answered correctly.

3. (1c) Commands (two simple commands): Score 0. Which is correct?
A. Performs only one command
B. Performs commands with marked delay
C. ✔ Performs both commands correctly and promptly.
D. Refuses to follow commands
Rationale: Score 0 indicates commands were followed without difficulty.

4. (2) Best gaze: Score 0. Which is true?
A. Partial gaze palsy
B. Forced deviation of gaze
C. ✔ Normal horizontal eye movements and tracking.
D. Complete gaze palsy
Rationale: Score 0 = no gaze abnormality.

5. (3) Visual fields: Score 0. Which describes this?
A. Complete hemianopia
B. Quadrantanopia
C. Partial hemianopia
D. ✔ Full visual fields on confrontation testing.
Rationale: Score 0 denotes no visual field deficit.

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6. (4) Facial palsy: Score 0. Which is correct?
A. Minor asymmetry on close inspection
B. Lower-face droop only
C. ✔ Symmetric facial movement; no facial weakness.
D. Complete hemifacial paralysis
Rationale: Score 0 = normal facial motor function.

7. (5a) Motor arm — left: Score 0. Which choice matches?
A. Mild drift but holds against gravity
B. Slight movement only to pain
C. ✔ Holds arm up 10 seconds with no drift.
D. No movement at all
Rationale: Score 0 indicates normal strength—no drift during the 10-second test.

8. (5b) Motor arm — right: Score 0. Which?
A. Some drift present
B. ✔ Holds arm without drift for the full test interval.
C. Falls to bed before 10 seconds
D. No movement
Rationale: Score 0 = full motor strength for the tested arm.

9. (6a) Motor leg — left: Score 0. Which is correct?
A. Falls to bed before 5 seconds
B. Some drift but remains elevated
C. ✔ Raises leg and holds for required interval with no drift.
D. No movement
Rationale: Score 0 indicates normal leg strength on the tested side.

10. (6b) Motor leg — right: Score 0. Which?
A. Drift present
B. ✔ Holds leg up for required time; no drift.
C. No effort against gravity
D. No movement
Rationale: Score 0 = intact leg motor function.

11. (7) Limb ataxia / coordination: Score 0. Which is true?
A. Dysmetria on finger-to-nose testing
B. ✔ No limb ataxia; coordination intact.
C. Ataxia in one limb only

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D. Ataxia in all limbs
Rationale: Score 0 = absent limb ataxia.



Case 2 — “1,2,3,4,5 and a 1/2”

(scores: 1b=1, 4=1, 5b=4, 6b=3, 8=1, 9=1; others mostly 0)

12. (1a) LOC: Score 0 — choose the statement that matches.
A. Drowsy and hard to arouse
B. ✔ Alert and responsive.
C. Requires repeated stimulation to arouse
D. Unresponsive
Rationale: 0 = fully alert.

13. (1b) Orientation (two questions): Score 1. What does this indicate?
A. Answers both correctly
B. ✔ Answers one of two orientation questions correctly.
C. Answers neither correctly
D. Not testable
Rationale: Score 1 = partially oriented (one correct).

14. (1c) Commands: Score 0 — which fits?
A. Performs only one command
B. ✔ Performs both commands correctly.
C. Performs no commands
D. Refuses
Rationale: Score 0 = follows both commands.

15. (2) Best gaze: Score 0 — which is true?
A. Partial gaze palsy
B. Forced deviation
C. ✔ Normal gaze and tracking.
D. Complete gaze palsy
Rationale: Score 0 = no gaze abnormality.

16. (3) Visual fields: Score 0 — pick correct statement.
A. Quadrantanopia
B. Partial hemianopia
C. ✔ Full visual fields.