APEX NIH STROKE SCALE
TRAINING MODULE 2025 – GROUP
A (PATIENTS 1-6) – COMPLETE
GUIDE
PATIENT 1 – Mild Right-Sided Weakness and
Sensory Deficit
Presentation/Vignette: A 68-year-old male presents 90 minutes after sudden
onset of right arm weakness and numbness. He is alert and fully oriented. He
follows all commands appropriately. No facial asymmetry is noted at rest, but
mild right-sided droop appears with effort (e.g., when asked to show teeth). He
has mild right arm drift but can hold against gravity for 10 seconds. Right leg
shows no drift. Sensation is mildly decreased on the right side. Speech is fluent,
clear, and without errors. No gaze palsy, visual field deficit, or ataxia.
NIHSS Assessment & Scoring:
1a. Level of Consciousness – Loc: Score: 0 Rationale: Patient is alert and
responsive.
1b. LOC Questions: Score: 0 Rationale: Patient correctly answers both age and
current month.
1c. LOC Commands: Score: 0 Rationale: Patient correctly performs both simple
tasks (open/close eyes, grip/release hand).
2. Best Gaze: Score: 0 Rationale: Normal conjugate gaze in all directions; no
forced deviation.
, 3. Visual Fields: Score: 0 Rationale: No visual field deficit; patient responds to
finger movements in all quadrants.
4. Facial Palsy: Score: 1 Rationale: Mild right facial weakness is evident only
with effort (e.g., showing teeth), consistent with partial palsy.
5a. Motor Arm – Left: Score: 0 Rationale: Left arm holds position against
gravity for full 10 seconds with no drift.
5b. Motor Arm – Right: Score: 1 Rationale: Right arm shows mild drift but
does not fall; holds against gravity for most of 10 seconds.
6a. Motor Leg – Left: Score: 0 Rationale: Left leg maintains 30-degree
elevation for full 5 seconds.
6b. Motor Leg – Right: Score: 0 Rationale: No leg drift or weakness observed
on right side.
7. Limb Ataxia: Score: 0 Rationale: Patient performs finger-nose and heel-shin
tests smoothly and accurately on both sides; no ataxia.
8. Sensory: Score: 1 Rationale: Patient reports mild sensory loss on the right
side to pinprick or other tested modality, but not total loss.
9. Best Language: Score: 0 Rationale: Speech is fluent, clear, and without
paraphasias or word-finding difficulty.
10. Dysarthria: Score: 0 Rationale: Articulation is normal; no slurring or motor
speech impairment.
11. Extinction and Inattention: Score: 0 Rationale: Patient responds normally
to bilateral simultaneous stimulation; no extinction or inattention.
TOTAL NIHSS SCORE for Patient 1: 3
TRAINING MODULE 2025 – GROUP
A (PATIENTS 1-6) – COMPLETE
GUIDE
PATIENT 1 – Mild Right-Sided Weakness and
Sensory Deficit
Presentation/Vignette: A 68-year-old male presents 90 minutes after sudden
onset of right arm weakness and numbness. He is alert and fully oriented. He
follows all commands appropriately. No facial asymmetry is noted at rest, but
mild right-sided droop appears with effort (e.g., when asked to show teeth). He
has mild right arm drift but can hold against gravity for 10 seconds. Right leg
shows no drift. Sensation is mildly decreased on the right side. Speech is fluent,
clear, and without errors. No gaze palsy, visual field deficit, or ataxia.
NIHSS Assessment & Scoring:
1a. Level of Consciousness – Loc: Score: 0 Rationale: Patient is alert and
responsive.
1b. LOC Questions: Score: 0 Rationale: Patient correctly answers both age and
current month.
1c. LOC Commands: Score: 0 Rationale: Patient correctly performs both simple
tasks (open/close eyes, grip/release hand).
2. Best Gaze: Score: 0 Rationale: Normal conjugate gaze in all directions; no
forced deviation.
, 3. Visual Fields: Score: 0 Rationale: No visual field deficit; patient responds to
finger movements in all quadrants.
4. Facial Palsy: Score: 1 Rationale: Mild right facial weakness is evident only
with effort (e.g., showing teeth), consistent with partial palsy.
5a. Motor Arm – Left: Score: 0 Rationale: Left arm holds position against
gravity for full 10 seconds with no drift.
5b. Motor Arm – Right: Score: 1 Rationale: Right arm shows mild drift but
does not fall; holds against gravity for most of 10 seconds.
6a. Motor Leg – Left: Score: 0 Rationale: Left leg maintains 30-degree
elevation for full 5 seconds.
6b. Motor Leg – Right: Score: 0 Rationale: No leg drift or weakness observed
on right side.
7. Limb Ataxia: Score: 0 Rationale: Patient performs finger-nose and heel-shin
tests smoothly and accurately on both sides; no ataxia.
8. Sensory: Score: 1 Rationale: Patient reports mild sensory loss on the right
side to pinprick or other tested modality, but not total loss.
9. Best Language: Score: 0 Rationale: Speech is fluent, clear, and without
paraphasias or word-finding difficulty.
10. Dysarthria: Score: 0 Rationale: Articulation is normal; no slurring or motor
speech impairment.
11. Extinction and Inattention: Score: 0 Rationale: Patient responds normally
to bilateral simultaneous stimulation; no extinction or inattention.
TOTAL NIHSS SCORE for Patient 1: 3
