NIHSS – STROKE SCALE CERTIFICATION EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
Question 1
A 68-year-old male presents with sudden onset of right-sided weakness and slurred
speech. On exam:
Level of Consciousness: Alert and responsive
Best Gaze: Eyes deviated slightly to the left
Visual Fields: Right homonymous hemianopia
Facial Palsy: Right lower face weakness
Motor Arm (Right): 3/5 strength
Motor Leg (Right): 4/5 strength
Limb Ataxia: None
Sensory: Decreased sensation on the right side
Best Language: Mild expressive aphasia
Dysarthria: Mild
Extinction & Inattention: Right-sided neglect
Question: What is the approximate NIHSS score for this patient?
A) 8
B) 12
C) 15
D) 18
Answer: B) 12
,Rationale:
NIHSS scoring:
Level of consciousness: 0 (alert)
Best gaze: 1 (partial gaze palsy)
Visual fields: 2 (complete hemianopia)
Facial palsy: 1 (minor paralysis)
Motor arm: 3 (3/5)
Motor leg: 1 (4/5)
Limb ataxia: 0
Sensory: 1 (mild to moderate)
Language: 1 (mild aphasia)
Dysarthria: 1 (mild)
Extinction & inattention: 2 (severe neglect)
Total = 12
,Question 2
A 74-year-old female with a history of atrial fibrillation is brought to the ER with
sudden onset left-sided weakness and slurred speech. On NIHSS assessment:
Level of Consciousness: Alert, but disoriented to time
Best Gaze: Normal
Visual Fields: Full
Facial Palsy: Left upper and lower face weakness
Motor Arm (Left): 0/5
Motor Leg (Left): 2/5
Limb Ataxia: Unable to assess due to weakness
Sensory: Severe left-sided sensory loss
Best Language: Global aphasia
Dysarthria: Moderate
Extinction & Inattention: Left-sided neglect
Question: Which NIHSS items contribute most significantly to predicting poor
functional outcomes?
A) Level of Consciousness & Best Gaze
B) Motor Arm & Leg, Language, Extinction/Inattention
C) Dysarthria & Facial Palsy
D) Visual Fields & Limb Ataxia
Answer: B) Motor Arm & Leg, Language, Extinction/Inattention
Rationale:
Studies show that the severity of motor deficits, global aphasia, and neglect are
strong predictors of poor functional outcomes in acute stroke. While other NIHSS
items are important for scoring, these deficits correlate most with disability and
long-term prognosis.
, Question 3
During a NIHSS exam, you observe a patient with severe right-sided hemiplegia
but intact language and cognition. Which NIHSS items will likely contribute the
highest individual scores?
A) Motor Arm & Leg
B) Best Language & Dysarthria
C) Visual Fields & Extinction/Inattention
D) Limb Ataxia & Facial Palsy
Answer: A) Motor Arm & Leg
Rationale:
The NIHSS assigns higher point values to motor deficits. Severe hemiplegia
scores up to 4 points for each limb, which will dominate the overall NIHSS score,
while language or minor facial deficits contribute fewer points.
Question 4
A 70-year-old man presents with sudden left-sided weakness. Exam:
Alert and oriented
Eyes deviate to the right
Left homonymous hemianopia
Left lower face weakness
Motor arm (left) 3/5, leg (left) 4/5
No limb ataxia
Mild left-sided sensory loss
Mild expressive aphasia
Mild dysarthria
No extinction or neglect
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
Question 1
A 68-year-old male presents with sudden onset of right-sided weakness and slurred
speech. On exam:
Level of Consciousness: Alert and responsive
Best Gaze: Eyes deviated slightly to the left
Visual Fields: Right homonymous hemianopia
Facial Palsy: Right lower face weakness
Motor Arm (Right): 3/5 strength
Motor Leg (Right): 4/5 strength
Limb Ataxia: None
Sensory: Decreased sensation on the right side
Best Language: Mild expressive aphasia
Dysarthria: Mild
Extinction & Inattention: Right-sided neglect
Question: What is the approximate NIHSS score for this patient?
A) 8
B) 12
C) 15
D) 18
Answer: B) 12
,Rationale:
NIHSS scoring:
Level of consciousness: 0 (alert)
Best gaze: 1 (partial gaze palsy)
Visual fields: 2 (complete hemianopia)
Facial palsy: 1 (minor paralysis)
Motor arm: 3 (3/5)
Motor leg: 1 (4/5)
Limb ataxia: 0
Sensory: 1 (mild to moderate)
Language: 1 (mild aphasia)
Dysarthria: 1 (mild)
Extinction & inattention: 2 (severe neglect)
Total = 12
,Question 2
A 74-year-old female with a history of atrial fibrillation is brought to the ER with
sudden onset left-sided weakness and slurred speech. On NIHSS assessment:
Level of Consciousness: Alert, but disoriented to time
Best Gaze: Normal
Visual Fields: Full
Facial Palsy: Left upper and lower face weakness
Motor Arm (Left): 0/5
Motor Leg (Left): 2/5
Limb Ataxia: Unable to assess due to weakness
Sensory: Severe left-sided sensory loss
Best Language: Global aphasia
Dysarthria: Moderate
Extinction & Inattention: Left-sided neglect
Question: Which NIHSS items contribute most significantly to predicting poor
functional outcomes?
A) Level of Consciousness & Best Gaze
B) Motor Arm & Leg, Language, Extinction/Inattention
C) Dysarthria & Facial Palsy
D) Visual Fields & Limb Ataxia
Answer: B) Motor Arm & Leg, Language, Extinction/Inattention
Rationale:
Studies show that the severity of motor deficits, global aphasia, and neglect are
strong predictors of poor functional outcomes in acute stroke. While other NIHSS
items are important for scoring, these deficits correlate most with disability and
long-term prognosis.
, Question 3
During a NIHSS exam, you observe a patient with severe right-sided hemiplegia
but intact language and cognition. Which NIHSS items will likely contribute the
highest individual scores?
A) Motor Arm & Leg
B) Best Language & Dysarthria
C) Visual Fields & Extinction/Inattention
D) Limb Ataxia & Facial Palsy
Answer: A) Motor Arm & Leg
Rationale:
The NIHSS assigns higher point values to motor deficits. Severe hemiplegia
scores up to 4 points for each limb, which will dominate the overall NIHSS score,
while language or minor facial deficits contribute fewer points.
Question 4
A 70-year-old man presents with sudden left-sided weakness. Exam:
Alert and oriented
Eyes deviate to the right
Left homonymous hemianopia
Left lower face weakness
Motor arm (left) 3/5, leg (left) 4/5
No limb ataxia
Mild left-sided sensory loss
Mild expressive aphasia
Mild dysarthria
No extinction or neglect
