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NIH Stroke Scale (NIHSS) Guide 2025: PDF Download, Scoring & Certification

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Access the official NIH Stroke Scale (NIHSS) PDF. This 2025 guide includes the complete scoring sheet, detailed administration instructions, and online certification resources for healthcare professionals to accurately assess stroke severity.

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NIH Stroke Scale – All Test Groups A - F (Patients 1-6) &

NIHSS Certification Exam Review 2025 Answers Key (

A + GRADED 100% VERIFIED)

How to assess Level of Consciousness? .....ANSWER.....1a.

Deteremine if patient is alert, oriented x4




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

,Page 2 of 21


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? .....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.

, Page 3 of 21


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? .....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? .....ANSWER.....0 = Normal.
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