NIH STROKE SCALE FINAL STUDY GUIDE 2026
SOLVED ITEMS PREMIUM REVIEW
◉ 1C. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked to open and close the eyes and then to grip and release the
nonparetic 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. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
◉ 2. Best Gaze NIHSS Scoring. Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze
palsy.
0 - Normal
1 - Partial gaze palsy; gaze is abnormal in one or both eyes, but
forced deviation or total gaze paresis is not present
2 - Forced deviation, or total gaze paresis is not overcome by the
oculocephalic maneuver.
, ◉ 3 Visual NIHSS Scoring. Answer: Visual fields (upper and lower
quadrants) are tested by confrontation, using finger counting or
visual threat, as appropriate. Have pt cover individual eye and look
at your nose. Flash numbers in peripheral vision.
0 - No visual loss
1 - Partial hemianopia (loss of half of visions field)
2 - Complete hemianopia
3 - Bilateral hemianopia (blind including cortical blindness)
◉ 4 Facial Palsy NIHSS Scoring. Answer: Ask pt to show teeth or
raise eyebrows and close eyes. Score symmetry of grimace.
0 - Normal symmetrical movements
1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
2 - Partial paralysis (total or near-total paralysis of lower face)
3 - Complete paralysis of one or both sides (absence of facial
movement in the upper and lower face)
◉ 5. Motor Arm NIHSS Scoring. Answer: The limb is placed in the
appropriate position: extend the arms (palms down) 90 degrees (if
sitting) or 45 degrees (if supine). Drift is scored if the arm falls
before 10 seconds. Each limb is tested in turn, beginning with the
non-paretic arm.
0 - No drift; limb holds 90 (or 45) degrees for full 10 seconds
SOLVED ITEMS PREMIUM REVIEW
◉ 1C. Level of Consciousness (LOC) Scoring. Answer: The patient is
asked to open and close the eyes and then to grip and release the
nonparetic 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. Only the first attempt is scored.
0 - Performs both tasks correctly
1 - Performs one task correctly
2 - Performs neither task correctly.
◉ 2. Best Gaze NIHSS Scoring. Answer: Best Gaze Instructions: Only
horizontal eye movements will be tested. Voluntary or reflexive
(oculocephalic) eye movements will be scored
Establishing eye contact and then moving about the patient from
side to side will occasionally clarify the presence of a partial gaze
palsy.
0 - Normal
1 - Partial gaze palsy; gaze is abnormal in one or both eyes, but
forced deviation or total gaze paresis is not present
2 - Forced deviation, or total gaze paresis is not overcome by the
oculocephalic maneuver.
, ◉ 3 Visual NIHSS Scoring. Answer: Visual fields (upper and lower
quadrants) are tested by confrontation, using finger counting or
visual threat, as appropriate. Have pt cover individual eye and look
at your nose. Flash numbers in peripheral vision.
0 - No visual loss
1 - Partial hemianopia (loss of half of visions field)
2 - Complete hemianopia
3 - Bilateral hemianopia (blind including cortical blindness)
◉ 4 Facial Palsy NIHSS Scoring. Answer: Ask pt to show teeth or
raise eyebrows and close eyes. Score symmetry of grimace.
0 - Normal symmetrical movements
1 - Minor paralysis (flattened nasolabial fold, asymmetry on smiling)
2 - Partial paralysis (total or near-total paralysis of lower face)
3 - Complete paralysis of one or both sides (absence of facial
movement in the upper and lower face)
◉ 5. Motor Arm NIHSS Scoring. Answer: The limb is placed in the
appropriate position: extend the arms (palms down) 90 degrees (if
sitting) or 45 degrees (if supine). Drift is scored if the arm falls
before 10 seconds. Each limb is tested in turn, beginning with the
non-paretic arm.
0 - No drift; limb holds 90 (or 45) degrees for full 10 seconds
