NIHSS-English Group E-V3

NIHSS-English Group E-V3 Patient 1 - ANS-1a. Level of Consciousness: 0 1b. LOC Questions: 0 1c. LOC Commands: 0 2. Best Gaze: 0 3. Visual: 0 4. Facial Palsy: 0 5a. Motor Arm Left:0 5b. Motor Arm Right:0 6a. Left Leg:0 6b. Right Leg: 1 7. Limb Ataxia: 0 8. Sensory: 1 9. Best Language: 0 10. Dysarthria: 0 11. Extinction and Inattention (formerly Neglect): 0 How many areas are tested and scored in the NIHSS? - ANS-11 What are the 11 areas tested in the NIHSS in order? - ANS-1) Level of Consciousness 2) Best Gaze 3) Visual Fields 4) Facial Palsy 5) Motor Arm 6) Motor Leg 7) Limb Ataxia 8) Sensory 9) Language 10) Dysarthria 11) Extinction/Inattention What are the 3 parts of assessing the LOC? - ANS-1a) Alertness 1b) Orientation (Month and Age) 1c) Blink eyes and Squeeze Hands If a person scores less than a 3 in assessing alertness (1a) but is nearly comatose, what implication does it have? - ANS-All other areas of NIHSS must be assessed, but will likely fall back on defaulted scores. How would you score orientation (1b) on a patient who is unable to communicate due to being intubated/dysarthric/facial trauma/language barrier? - ANS-1 How would you score orientation (1b) on a patient who is comatose, stuporous, aphasic, or scores a 3 on part 1a? - ANS-2 When assessing a persons orientation (1b), what if the patient states the wrong answer then changes it to a correct answer? - ANS-Score the initial wrong answer How do you score ability to follow commands if a patient makes an attempt but is unable to do so due to weakness? - ANS-Give credit for the attempt How do you assess gaze in a comatose patient? - ANSUse occulocephalic maneuver (Doll's eyes) How to test gaze in a patient who is unable to follow finger due to confusion or aphasia? - ANS-Make eye contact and move from side to side How to score gaze palsy (2)? - ANS-If normal, then 0 If gaze palsy cannot be overcome (with occulocephalic), then 2 Everything else, then 1 How to assess visual fields in patient who is aphasic or is comatose (scored a 3 in part 1a)? - ANS-Visual Threat How do you score a patient with extinction on the visual fields assessment? - ANS-1 What is the difference between a score of 1 and 2 on visual fields? - ANS-1 = Partial Hemianopia (Able to answer some fingers correctly) 2 = Complete Hemianopia (Unable to see fingers at all) At the end of assessing visual fields, what else can you check? - ANS-Double simultaneous stimulation to visual input