ESTUDYR
NIH STROKE SCALE GROUP F
Case 1 — “black man, asian doctor with red tie”
(Recorded scores: 1a=0, 1b=1, 1c=0, 2=0, 3=0, 4=1, 5a=0, 5b=1, 6a=0, 6b=0, 7=0, 8=0, 9=0,
10=1, 11=0)
Q1 (1a) Level of consciousness — recorded: 0
A. Drowsy; requires repeated stimulation
B. Somnolent but arousable only to voice
C. ✔ Alert and keenly responsive.
D. Unresponsive to painful stimuli
Rationale: Score 0 denotes a fully alert patient with no decreased LOC.
Q2 (1b) Orientation (time & age) — recorded: 1
A. ✔ Answers one of two orientation questions correctly.
B. Answers both correctly
C. Answers neither correctly
D. Not testable due to language barrier
Rationale: Score 1 = partial orientation (one correct).
Q3 (1c) Commands (2 simple commands) — recorded: 0
A. Performs only one command
B. Performs none
C. ✔ Performs both commands correctly.
D. Refuses to follow commands
Rationale: Score 0 = follows both commands without difficulty.
Q4 (2) Best gaze — recorded: 0
A. Partial gaze palsy (mild limitation)
B. Forced horizontal deviation
C. ✔ Normal horizontal gaze and tracking.
D. Complete gaze palsy
Rationale: Score 0 indicates no gaze abnormality.
Q5 (3) Visual fields — recorded: 0
A. Partial hemianopia
B. Quadrantanopia only
C. ✔ Full visual fields on confrontation testing.
,ESTUDYR
D. Complete bilateral hemianopia
Rationale: Score 0 = intact visual fields.
Q6 (4) Facial palsy — recorded: 1
A. ✔ Minor facial weakness (slight asymmetry, detectable on close inspection).
B. Partial facial paralysis (clear droop)
C. Complete hemifacial paralysis
D. Normal symmetric facial movement
Rationale: Score 1 corresponds to mild weakness.
Q7 (5a) Motor arm — left — recorded: 0
A. Mild drift but holds against gravity
B. Some effort only on testing
C. ✔ No drift; holds arm for full 10 seconds.
D. No movement at all
Rationale: Score 0 = normal arm strength.
Q8 (5b) Motor arm — right — recorded: 1
A. ✔ Drift: arm cannot hold the full 10 seconds but does not hit the bed.
B. No drift; full hold
C. No effort against gravity (arm falls)
D. No movement at all
Rationale: Score 1 indicates drift (mild weakness).
Q9 (6a) Motor leg — left — recorded: 0
A. Falls to bed before 5 seconds
B. Some drift but remains elevated
C. ✔ Holds leg for required interval with no drift.
D. No movement
Rationale: Score 0 = normal leg strength.
Q10 (6b) Motor leg — right — recorded: 0
A. Mild drift only
B. ✔ No drift; holds leg for the required interval.
C. No effort vs gravity
D. No movement
Rationale: Score 0 = intact right leg strength.
Q11 (7) Limb ataxia — recorded: 0
A. Dysmetria on finger-to-nose testing
, ESTUDYR
B. Ataxia in one limb only
C. ✔ No limb ataxia; coordination intact.
D. Ataxia in all assessed limbs
Rationale: Score 0 indicates normal coordination.
Q12 (8) Sensory — recorded: 0
A. ✔ Normal sensation to pinprick/light touch.
B. Mild sensory loss on one side
C. Severe sensory loss
D. Unable to cooperate
Rationale: Score 0 = normal sensory exam.
Q13 (9) Best language — recorded: 0
A. Mild aphasia only
B. ✔ Normal spontaneous speech, comprehension, naming, and repetition.
C. Severe global aphasia
D. Receptive aphasia only
Rationale: Score 0 = intact language function.
Q14 (10) Dysarthria — recorded: 1
A. ✔ Mild dysarthria — slight slur but intelligible.
B. Normal articulation
C. Severe dysarthria; unintelligible speech
D. Mutism
Rationale: Score 1 = mild impairment of articulation.
Q15 (11) Extinction/inattention — recorded: 0
A. Mild neglect only on double stimulation
B. ✔ No neglect or extinction observed.
C. Severe neglect with inability to detect one side
D. Not testable
Rationale: Score 0 = no inattention.
Case 2 — “lyden, older woman hospital bed, window curtains”
(Recorded scores: 1a=0, 1b=2, 1c=1, 2=0, 3=2, 4=0, 5a=0, 5b=4, 6a=0, 6b=4, 7=0, 8=2, 9=2,
10=1, 11=0)
NIH STROKE SCALE GROUP F
Case 1 — “black man, asian doctor with red tie”
(Recorded scores: 1a=0, 1b=1, 1c=0, 2=0, 3=0, 4=1, 5a=0, 5b=1, 6a=0, 6b=0, 7=0, 8=0, 9=0,
10=1, 11=0)
Q1 (1a) Level of consciousness — recorded: 0
A. Drowsy; requires repeated stimulation
B. Somnolent but arousable only to voice
C. ✔ Alert and keenly responsive.
D. Unresponsive to painful stimuli
Rationale: Score 0 denotes a fully alert patient with no decreased LOC.
Q2 (1b) Orientation (time & age) — recorded: 1
A. ✔ Answers one of two orientation questions correctly.
B. Answers both correctly
C. Answers neither correctly
D. Not testable due to language barrier
Rationale: Score 1 = partial orientation (one correct).
Q3 (1c) Commands (2 simple commands) — recorded: 0
A. Performs only one command
B. Performs none
C. ✔ Performs both commands correctly.
D. Refuses to follow commands
Rationale: Score 0 = follows both commands without difficulty.
Q4 (2) Best gaze — recorded: 0
A. Partial gaze palsy (mild limitation)
B. Forced horizontal deviation
C. ✔ Normal horizontal gaze and tracking.
D. Complete gaze palsy
Rationale: Score 0 indicates no gaze abnormality.
Q5 (3) Visual fields — recorded: 0
A. Partial hemianopia
B. Quadrantanopia only
C. ✔ Full visual fields on confrontation testing.
,ESTUDYR
D. Complete bilateral hemianopia
Rationale: Score 0 = intact visual fields.
Q6 (4) Facial palsy — recorded: 1
A. ✔ Minor facial weakness (slight asymmetry, detectable on close inspection).
B. Partial facial paralysis (clear droop)
C. Complete hemifacial paralysis
D. Normal symmetric facial movement
Rationale: Score 1 corresponds to mild weakness.
Q7 (5a) Motor arm — left — recorded: 0
A. Mild drift but holds against gravity
B. Some effort only on testing
C. ✔ No drift; holds arm for full 10 seconds.
D. No movement at all
Rationale: Score 0 = normal arm strength.
Q8 (5b) Motor arm — right — recorded: 1
A. ✔ Drift: arm cannot hold the full 10 seconds but does not hit the bed.
B. No drift; full hold
C. No effort against gravity (arm falls)
D. No movement at all
Rationale: Score 1 indicates drift (mild weakness).
Q9 (6a) Motor leg — left — recorded: 0
A. Falls to bed before 5 seconds
B. Some drift but remains elevated
C. ✔ Holds leg for required interval with no drift.
D. No movement
Rationale: Score 0 = normal leg strength.
Q10 (6b) Motor leg — right — recorded: 0
A. Mild drift only
B. ✔ No drift; holds leg for the required interval.
C. No effort vs gravity
D. No movement
Rationale: Score 0 = intact right leg strength.
Q11 (7) Limb ataxia — recorded: 0
A. Dysmetria on finger-to-nose testing
, ESTUDYR
B. Ataxia in one limb only
C. ✔ No limb ataxia; coordination intact.
D. Ataxia in all assessed limbs
Rationale: Score 0 indicates normal coordination.
Q12 (8) Sensory — recorded: 0
A. ✔ Normal sensation to pinprick/light touch.
B. Mild sensory loss on one side
C. Severe sensory loss
D. Unable to cooperate
Rationale: Score 0 = normal sensory exam.
Q13 (9) Best language — recorded: 0
A. Mild aphasia only
B. ✔ Normal spontaneous speech, comprehension, naming, and repetition.
C. Severe global aphasia
D. Receptive aphasia only
Rationale: Score 0 = intact language function.
Q14 (10) Dysarthria — recorded: 1
A. ✔ Mild dysarthria — slight slur but intelligible.
B. Normal articulation
C. Severe dysarthria; unintelligible speech
D. Mutism
Rationale: Score 1 = mild impairment of articulation.
Q15 (11) Extinction/inattention — recorded: 0
A. Mild neglect only on double stimulation
B. ✔ No neglect or extinction observed.
C. Severe neglect with inability to detect one side
D. Not testable
Rationale: Score 0 = no inattention.
Case 2 — “lyden, older woman hospital bed, window curtains”
(Recorded scores: 1a=0, 1b=2, 1c=1, 2=0, 3=2, 4=0, 5a=0, 5b=4, 6a=0, 6b=4, 7=0, 8=2, 9=2,
10=1, 11=0)
