, NIHSS (STROKE SCALE) GROUP A – CASE
SCENARIOS (PATIENTS 1–6) CERTIFICATION
PATIENT 1
1. A 68-year-old patient is brought to the emergency department 90 minutes after suddenly
developing difficulty speaking and weakness on the left side. The patient is alert and able to
answer both orientation questions correctly and follows both commands appropriately. Gaze
is normal, but examination reveals a partial left facial weakness, no movement of the left
arm, and mild drift of the left leg. The patient has severe sensory loss on the left side, mild-
to-moderate aphasia, no significant dysarthria, and mild extinction to bilateral stimulation.
NIHSS Correct Answers:
1a. Level of Consciousness: 0
1b. LOC Questions: 0
1c. LOC Commands: 0
2. Best Gaze: 0
3. Visual Fields: 0
4. Facial Palsy: 1
5a. Motor Left Arm: 3
5b. Motor Right Arm: 0
6a. Motor Left Leg: 1
6b. Motor Right Leg: 0
7. Limb Ataxia: 1
8. Sensory: 2
9. Best Language: 0
10. Dysarthria: 0
11. Extinction and Inattention: 1
, PATIENT 2
2. A 72-year-old patient presents with sudden neurological changes that began
approximately two hours ago. The patient is awake, follows commands appropriately, and
has normal gaze and visual fields, with only mild facial weakness noted on examination. The
patient demonstrates normal strength in all four extremities but has a moderate impairment
in sensation on one side and mild-to-moderate aphasia, with mild dysarthria during
conversation. There is no evidence of limb ataxia or extinction/inattention.
NIHSS Correct Answers:
1a. Level of Consciousness: 0
1b. LOC Questions: 2
1c. LOC Commands: 0
2. Best Gaze: 0
3. Visual Fields: 0
4. Facial Palsy: 1
5a. Motor Left Arm: 0
5b. Motor Right Arm: 0
6a. Motor Left Leg: 0
6b. Motor Right Leg: 0
7. Limb Ataxia: 0
8. Sensory: 1
9. Best Language: 2
10. Dysarthria: 1
11. Extinction and Inattention: 0
SCENARIOS (PATIENTS 1–6) CERTIFICATION
PATIENT 1
1. A 68-year-old patient is brought to the emergency department 90 minutes after suddenly
developing difficulty speaking and weakness on the left side. The patient is alert and able to
answer both orientation questions correctly and follows both commands appropriately. Gaze
is normal, but examination reveals a partial left facial weakness, no movement of the left
arm, and mild drift of the left leg. The patient has severe sensory loss on the left side, mild-
to-moderate aphasia, no significant dysarthria, and mild extinction to bilateral stimulation.
NIHSS Correct Answers:
1a. Level of Consciousness: 0
1b. LOC Questions: 0
1c. LOC Commands: 0
2. Best Gaze: 0
3. Visual Fields: 0
4. Facial Palsy: 1
5a. Motor Left Arm: 3
5b. Motor Right Arm: 0
6a. Motor Left Leg: 1
6b. Motor Right Leg: 0
7. Limb Ataxia: 1
8. Sensory: 2
9. Best Language: 0
10. Dysarthria: 0
11. Extinction and Inattention: 1
, PATIENT 2
2. A 72-year-old patient presents with sudden neurological changes that began
approximately two hours ago. The patient is awake, follows commands appropriately, and
has normal gaze and visual fields, with only mild facial weakness noted on examination. The
patient demonstrates normal strength in all four extremities but has a moderate impairment
in sensation on one side and mild-to-moderate aphasia, with mild dysarthria during
conversation. There is no evidence of limb ataxia or extinction/inattention.
NIHSS Correct Answers:
1a. Level of Consciousness: 0
1b. LOC Questions: 2
1c. LOC Commands: 0
2. Best Gaze: 0
3. Visual Fields: 0
4. Facial Palsy: 1
5a. Motor Left Arm: 0
5b. Motor Right Arm: 0
6a. Motor Left Leg: 0
6b. Motor Right Leg: 0
7. Limb Ataxia: 0
8. Sensory: 1
9. Best Language: 2
10. Dysarthria: 1
11. Extinction and Inattention: 0
