NIH Stroke Scale (NIHSS) – Actual Exam & Practice Test Latest 2025 Updated Questions
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1b. 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. It is important that only the initial
answer be graded and that the examiner not "help" the patient with verbal or non-verbal cue.
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic hand. If the patient does not respond to
command, the task
should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none, one
or two commands)
What are the results? - CORRECT ANSWER 0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey, answer,
or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or
painful stimulation to
make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and
areflexic.
0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
How to assess best gaze? - CORRECT ANSWER 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 1If a patient has an isolated peripheral nerve paresis (CN III,
IV or VI), score a 1
What are the results? - CORRECT ANSWER 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
, How to assess visual gaze? - CORRECT ANSWER Visual fields (upper and lower
quadrants) are tested by
confrontation, using finger counting or visual threat, as appropriate.
If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored.
If patient is blind from any cause, score 3.
Double simultaneous stimulation is performed at this point. If there is extinction, patient receives
a 1, and the results are used to respond to item 11.
What are the results? - CORRECT ANSWER 0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
How to assess facial palsy? - CORRECT ANSWER Ask - or use pantomime to
encourage - the patient
to show teeth or raise eyebrows and close eyes. Score symmetry of grimace in response to
noxious stimuli in the poorly responsive or non-comprehending patient.
What are the results? - CORRECT ANSWER 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)
How to assess motor arm and leg? - CORRECT 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. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-
paretic arm.
What are the results? - CORRECT ANSWER 0 = No drift; limb holds 90 (or 45)
degrees for full 10 seconds.
1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10
seconds; does not hit bed or other support.
2 = Some effort against gravity; limb cannot get to or
maintain (if cued) 90 (or 45) degrees, drifts down to bed, but
has some effort against gravity.
3 = No effort against gravity; limb falls.
4 = No movement.
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1b. 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. It is important that only the initial
answer be graded and that the examiner not "help" the patient with verbal or non-verbal cue.
1c. The patient is asked to open and close the
eyes and then to grip and release the non-paretic hand. If the patient does not respond to
command, the task
should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none, one
or two commands)
What are the results? - CORRECT ANSWER 0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey, answer,
or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or
painful stimulation to
make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, and
areflexic.
0 = Answers both questions correctly.
1 = Answers one question correctly.
2 = Answers neither question correctly
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
How to assess best gaze? - CORRECT ANSWER 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 1If a patient has an isolated peripheral nerve paresis (CN III,
IV or VI), score a 1
What are the results? - CORRECT ANSWER 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
, How to assess visual gaze? - CORRECT ANSWER Visual fields (upper and lower
quadrants) are tested by
confrontation, using finger counting or visual threat, as appropriate.
If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored.
If patient is blind from any cause, score 3.
Double simultaneous stimulation is performed at this point. If there is extinction, patient receives
a 1, and the results are used to respond to item 11.
What are the results? - CORRECT ANSWER 0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
How to assess facial palsy? - CORRECT ANSWER Ask - or use pantomime to
encourage - the patient
to show teeth or raise eyebrows and close eyes. Score symmetry of grimace in response to
noxious stimuli in the poorly responsive or non-comprehending patient.
What are the results? - CORRECT ANSWER 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)
How to assess motor arm and leg? - CORRECT 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. The aphasic patient is encouraged using urgency in the voice and
pantomime, but not noxious stimulation. Each limb is tested in turn, beginning with the non-
paretic arm.
What are the results? - CORRECT ANSWER 0 = No drift; limb holds 90 (or 45)
degrees for full 10 seconds.
1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10
seconds; does not hit bed or other support.
2 = Some effort against gravity; limb cannot get to or
maintain (if cued) 90 (or 45) degrees, drifts down to bed, but
has some effort against gravity.
3 = No effort against gravity; limb falls.
4 = No movement.
