NIHSS CERTIFICATION QUESTIONS AND ANSWERS
11 components of NIHSS - Answers - 1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC - Answers - 0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
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1a. Level of Consciousness: The investigator must choose a response, even if a full
evaluation is prevented by such obstacles as an endotracheal tube, language barrier,
orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement
(other than reflexive posturing) in response to noxious stimulation.*
1B - LOC Questions (2) - Answers - Month of year
Patient age
-----
0 = Answers both questions correctly
1 = Answers one question correctly
2 = Answers neither question correctly
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1b. LOC Questions: The patient is asked the month and his/her age. The answer must
be correct - there is no partial credit for being close. Aphasic and stuporous patients
who do not comprehend the questions will score 2. Patients unable to speak because of
endotracheal intubation, orotracheal trauma, severe dysarthria from any cause,
language barrier or any other problem not secondary to aphasia are given a 1. It is
important that only the initial answer be graded and that the examiner not "help" the
patient with verbal or non-verbal cues.*
1C - LOC Commands - Answers - Two tasks
, - Close your eye for me and now open
- Make a fist with your hand
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LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip
and release the non-paretic hand. Substitute another one step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not completed
due to weakness. If the patient does not respond to command, the task should be
demonstrated to them (pantomime) and score the result (i.e., follows none, one or two
commands). Patients with trauma, amputation, or other physical impediments should be
given suitable one-step commands. Only the first attempt is scored.*
Oculocephalic Maneuver - Answers - "Doll eyes" in comatose patient
Used to determine whether vestibule-ocular reflex pathway from medulla to the midbrain
is intact
2. Best Gaze - Answers - Tests horizontal eye movement. Ask pt to follow finger
0 = Normal
1 = Partlal gaze palsy
2 = Forced deviation
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Best Gaze: Only horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored but caloric testing is not done. If the
patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis
(CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients with ocular
trauma, bandages, pre-existing blindness or other disorder of visual acuity or fields
should be tested with reflexive movements and a choice made by the investigator.
Establishing eye contact and then moving about the patient from side to side will
occasionally clarify the presence of a partial gaze palsy.*
3 Visual Fields - Answers - *Count fingers in all four quadrants
*Ask pt to look into your own eye
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O = No visual loss
1 = Partial hemianopia
2 = Complete hemianopia
11 components of NIHSS - Answers - 1. LOC (Question & Command)
2. Gaze
3. Visual field
4. Facial palsy
5. Upper extremity
6. Lower extremity
7. Limb ataxia
8. Sensory
9. Best language
10. Dysarthria
11. Extinction & inattention
1A - LOC - Answers - 0 = Alert
1 = Not alert; aroused with minor verbal stimulation
2 = Not alert; requires strong or painful stimulation
3 = Reflex movements only or totally unresponsive (COMA ~ try rub on chest)
---
1a. Level of Consciousness: The investigator must choose a response, even if a full
evaluation is prevented by such obstacles as an endotracheal tube, language barrier,
orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement
(other than reflexive posturing) in response to noxious stimulation.*
1B - LOC Questions (2) - Answers - Month of year
Patient age
-----
0 = Answers both questions correctly
1 = Answers one question correctly
2 = Answers neither question correctly
---
1b. LOC Questions: The patient is asked the month and his/her age. The answer must
be correct - there is no partial credit for being close. Aphasic and stuporous patients
who do not comprehend the questions will score 2. Patients unable to speak because of
endotracheal intubation, orotracheal trauma, severe dysarthria from any cause,
language barrier or any other problem not secondary to aphasia are given a 1. It is
important that only the initial answer be graded and that the examiner not "help" the
patient with verbal or non-verbal cues.*
1C - LOC Commands - Answers - Two tasks
, - Close your eye for me and now open
- Make a fist with your hand
--------
LEVEL OF CONSCIOUSNESS: COMMANDS
0 = Performs both tasks correctly
1 = Performs one task correctly
2 = Performs neither task correctly
--
1c. LOC Commands: The patient is asked to open and close the eyes and then to grip
and release the non-paretic hand. Substitute another one step command if the hands
cannot be used. Credit is given if an unequivocal attempt is made but not completed
due to weakness. If the patient does not respond to command, the task should be
demonstrated to them (pantomime) and score the result (i.e., follows none, one or two
commands). Patients with trauma, amputation, or other physical impediments should be
given suitable one-step commands. Only the first attempt is scored.*
Oculocephalic Maneuver - Answers - "Doll eyes" in comatose patient
Used to determine whether vestibule-ocular reflex pathway from medulla to the midbrain
is intact
2. Best Gaze - Answers - Tests horizontal eye movement. Ask pt to follow finger
0 = Normal
1 = Partlal gaze palsy
2 = Forced deviation
---
Best Gaze: Only horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored but caloric testing is not done. If the
patient has a conjugate deviation of the eyes that can be overcome by voluntary or
reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis
(CN III, IV or VI) score a 1. Gaze is testable in all aphasic patients. Patients with ocular
trauma, bandages, pre-existing blindness or other disorder of visual acuity or fields
should be tested with reflexive movements and a choice made by the investigator.
Establishing eye contact and then moving about the patient from side to side will
occasionally clarify the presence of a partial gaze palsy.*
3 Visual Fields - Answers - *Count fingers in all four quadrants
*Ask pt to look into your own eye
---
O = No visual loss
1 = Partial hemianopia
2 = Complete hemianopia
