NIH Stroke Scale Group E
Exam 2026 – Actual Questions
with 100% Correct Answers,
Rationales & Graded A+
1. A patient is alert, knows the month and age, and follows both
commands.
Answer: 1a = 0; 1b = 0; 1c = 0.
Rationale: Full alertness, both orientation questions correct, and both
commands performed each score 0.
2. A patient is drowsy but arouses with light stimulation and answers
only the month correctly.
Answer: 1a = 1; 1b = 1.
Rationale: Drowsiness requiring mild stimulation scores 1; one
correct orientation answer scores 1.
3. A patient requires repeated stimulation to respond and follows
neither command.
Answer: 1a = 2; 1c = 2.
Rationale: Repeated stimulation or painful stimulation with
purposeful movement scores 2; neither command performed scores
2.
4. A comatose patient has no response to stimulation.
Answer: 1a = 3.
Rationale: Coma is scored 3 on level of consciousness.
,5. A patient’s eyes deviate to the right and cannot be brought past
midline to the left.
Answer: Best gaze = 2.
Rationale: Forced deviation or total gaze paresis not overcome by
oculocephalic testing scores 2.
6. A patient has partial gaze palsy that is overcome with
oculocephalic maneuvers.
Answer: Best gaze = 1.
Rationale: Partial gaze palsy overcome by testing scores 1.
7. A patient has a left homonymous hemianopia.
Answer: Visual fields = 2.
Rationale: Complete hemianopia scores 2.
8. A patient has a partial visual-field deficit in one quadrant.
Answer: Visual fields = 1.
Rationale: Partial hemianopia, including a quadrant defect, scores 1.
9. A patient has mild lower-face asymmetry noticeable on smiling.
Answer: Facial palsy = 1.
Rationale: Minor facial paralysis, such as a flattened nasolabial fold
or slight asymmetry, scores 1.
10. A patient has near-total paralysis of the lower face.
Answer: Facial palsy = 2.
Rationale: Partial facial paralysis, especially obvious lower-face
weakness, scores 2.
11. A patient has complete paralysis of one or both sides of the face.
Answer: Facial palsy = 3.
Rationale: Complete unilateral or bilateral facial paralysis scores 3.
12. The left arm drifts down before 10 seconds but does not hit the
bed.
Answer: Motor arm left = 1.
Rationale: Drift without reaching the bed within 10 seconds scores 1.
, 13. The left arm falls to the bed immediately after elevation.
Answer: Motor arm left = 3.
Rationale: No effort against gravity, with the limb falling
immediately, scores 3.
14. The right arm cannot be raised against gravity but moves on the
bed.
Answer: Motor arm right = 2.
Rationale: Some effort against gravity is absent, but movement is
present; this scores 2.
15. The right arm moves only with reflex activity.
Answer: Motor arm right = 4.
Rationale: No movement or only reflex movement scores 4.
16. The left leg falls to the bed within 5 seconds after elevation.
Answer: Motor leg left = 3.
Rationale: No effort against gravity, with the leg falling within 5
seconds, scores 3.
17. The right leg drifts down before 5 seconds but does not reach the
bed.
Answer: Motor leg right = 1.
Rationale: Drift without reaching the bed within 5 seconds scores 1.
18. The left leg cannot be elevated but moves horizontally on the
bed.
Answer: Motor leg left = 2.
Rationale: Effort against gravity is absent, but some movement is
present; this scores 2.
19. A patient with normal strength performs finger-nose-finger
testing with clear decomposition and tremor.
Answer: Limb ataxia = 1.
Rationale: Ataxia in one limb, with sufficient strength to test, scores
1.
Exam 2026 – Actual Questions
with 100% Correct Answers,
Rationales & Graded A+
1. A patient is alert, knows the month and age, and follows both
commands.
Answer: 1a = 0; 1b = 0; 1c = 0.
Rationale: Full alertness, both orientation questions correct, and both
commands performed each score 0.
2. A patient is drowsy but arouses with light stimulation and answers
only the month correctly.
Answer: 1a = 1; 1b = 1.
Rationale: Drowsiness requiring mild stimulation scores 1; one
correct orientation answer scores 1.
3. A patient requires repeated stimulation to respond and follows
neither command.
Answer: 1a = 2; 1c = 2.
Rationale: Repeated stimulation or painful stimulation with
purposeful movement scores 2; neither command performed scores
2.
4. A comatose patient has no response to stimulation.
Answer: 1a = 3.
Rationale: Coma is scored 3 on level of consciousness.
,5. A patient’s eyes deviate to the right and cannot be brought past
midline to the left.
Answer: Best gaze = 2.
Rationale: Forced deviation or total gaze paresis not overcome by
oculocephalic testing scores 2.
6. A patient has partial gaze palsy that is overcome with
oculocephalic maneuvers.
Answer: Best gaze = 1.
Rationale: Partial gaze palsy overcome by testing scores 1.
7. A patient has a left homonymous hemianopia.
Answer: Visual fields = 2.
Rationale: Complete hemianopia scores 2.
8. A patient has a partial visual-field deficit in one quadrant.
Answer: Visual fields = 1.
Rationale: Partial hemianopia, including a quadrant defect, scores 1.
9. A patient has mild lower-face asymmetry noticeable on smiling.
Answer: Facial palsy = 1.
Rationale: Minor facial paralysis, such as a flattened nasolabial fold
or slight asymmetry, scores 1.
10. A patient has near-total paralysis of the lower face.
Answer: Facial palsy = 2.
Rationale: Partial facial paralysis, especially obvious lower-face
weakness, scores 2.
11. A patient has complete paralysis of one or both sides of the face.
Answer: Facial palsy = 3.
Rationale: Complete unilateral or bilateral facial paralysis scores 3.
12. The left arm drifts down before 10 seconds but does not hit the
bed.
Answer: Motor arm left = 1.
Rationale: Drift without reaching the bed within 10 seconds scores 1.
, 13. The left arm falls to the bed immediately after elevation.
Answer: Motor arm left = 3.
Rationale: No effort against gravity, with the limb falling
immediately, scores 3.
14. The right arm cannot be raised against gravity but moves on the
bed.
Answer: Motor arm right = 2.
Rationale: Some effort against gravity is absent, but movement is
present; this scores 2.
15. The right arm moves only with reflex activity.
Answer: Motor arm right = 4.
Rationale: No movement or only reflex movement scores 4.
16. The left leg falls to the bed within 5 seconds after elevation.
Answer: Motor leg left = 3.
Rationale: No effort against gravity, with the leg falling within 5
seconds, scores 3.
17. The right leg drifts down before 5 seconds but does not reach the
bed.
Answer: Motor leg right = 1.
Rationale: Drift without reaching the bed within 5 seconds scores 1.
18. The left leg cannot be elevated but moves horizontally on the
bed.
Answer: Motor leg left = 2.
Rationale: Effort against gravity is absent, but some movement is
present; this scores 2.
19. A patient with normal strength performs finger-nose-finger
testing with clear decomposition and tremor.
Answer: Limb ataxia = 1.
Rationale: Ataxia in one limb, with sufficient strength to test, scores
1.
