NIH Stroke Scale (NIHSS) Training Cases 2025 – Complete Group A-F Patient Assessments with Scoring & Interpretation

2025 NIH Stroke Scale – Group A (Patients 1–6)
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,Patient 1 – Mr. James X X X X




Clinical Scenario: X




Mr. James, a 72-year-old male, was found slumped on the right side of his couch. On
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arrival to the ER, he is drowsy, responds only to strong stimuli, and exhibits right-sided
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hemiplegia. He opens his eyes only to pain and does not respond to verbal commands.
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Speech is slurred and partially incomprehensible.
X X X X X X




NIH Stroke Scale Evaluation:
X X X




Item Description Score Notes
1a. LOC X Not alert; requires
X X 2 Requires painful X



repeated
X stimuli to arouse
X X X



stimulation
X



1b. LOC Questions
X X Cannot answer X 2 Unresponsive
month or age
X X X



1c. LOC Commands
X X Does not follow X X 2 No purposeful
X



commands
X Xmovement
2. Best Gaze
X X Partial gaze palsy X X 1 Incomplete eye X



Xmovement to one X X



Xside
3. Visual Fields
X X Complete 2 Right field deficit
X X



hemianopia
X



4. Facial Palsy
X X Complete paralysis X 2 Right facial droop
X X



(lower face)
X X



5a. Motor Arm (Left)
X X X No drift X 0 Moves normally X



5b. Motor Arm
X X No movement X 4 Flaccid
(Right)
X



6a. Motor Leg (Left)
X X X No drift X 0 Normal
6b. Motor Leg
X X No movement X 4 Flaccid
(Right)
X



7. Limb Ataxia
X X Not testable X NT Paralysis
8. Sensory
X Severe to total X X 2 No response to
X X



sensory loss
X X Xpinprick on right X X



Xside
9. Language
X Severe aphasia X 2 Speaks few words X X



Xonly
10. Dysarthria
X Severe 2 Slurred,
Xincomprehensible
11. Profound neglect X 2 Ignores right side X X



Extinction/Inattention
X Xcompletely

🟨 Total NIHSS Score: 27
X X X X




Interpretation: Severe stroke. High likelihood of poor prognosis without rapid
X X X X X X X X X




Xintervention.

,
, Patient 2 – Mrs. Linda
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Clinical Scenario: X




Mrs. Linda, a 68-year-old woman, presents with sudden onset of slurred speech and
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right-sided weakness. She is alert and oriented to person, place, and time. She follows
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commands but has some difficulty articulating words. She struggles to raise her right
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arm and leg but can move the left side without issue.
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NIH Stroke Scale Evaluation:
X X X




Item Description Score Notes
1a. LOC X Alert 0 Fully alert and X X



responsive
X



1b. LOC Questions
X X Answers both X 0 Oriented to month X X



correctly
X and age
X X



1c. LOC Commands
X X Follows both X 0 Raises hand and X X



commands
X opens/closes eyes
X X



correctly
X



2. Best Gaze
X X Normal 0 Smooth movement X



of eyes
X X



3. Visual Fields
X X No visual loss X X 0 Full fields intact
X X



4. Facial Palsy
X X Minor paralysis X 1 Slight right facial X X



droop
X



5a. Motor Arm (Left)
X X X No drift X 0 Full strength
X



5b. Motor Arm
X X Drifts but does not X X X 2 Weak but some X X



(Right)
X hit bed
X X effort
X



6a. Motor Leg (Left)
X X X No drift X 0 Full strength
X



6b. Motor Leg
X X Some effort against X X 2 Drift for <5 X X



(Right)
X gravity
X seconds
X



7. Limb Ataxia
X X None 0 No coordination
X



problems
X



8. Sensory
X Mild loss X 1 Slight decreased X



sensation to
X X



pinprick on right
X X X



side
X



9. Language
X Mild aphasia X 1 Hesitant but mostly X X



fluent
X



10. Dysarthria
X Mild 1 Slightly slurred but X X



understandable
X



11. None 0 Attends to both X X



Extinction/Inattention
X sides
X




🟨 Total NIHSS Score: 8
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Interpretation: Moderate stroke. Prompt management needed but prognosis may be
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Xfavorable.