NIHSS Group B Patient Examination

Question 1

A patient in the NIHSS Group B category is BEST described as someone who:

Accepted Answer

Has a known communication barrier, altered consciousness, intubation, or significant aphasia that limits the standard exam

Answer

Group B patients are those whose neurological deficits or medical status (e.g., intubation, profound aphasia, altered consciousness) create barriers to the standard NIHSS examination format. Group A patients are cooperative and able to follow standard instructions.

Question 2

When administering the NIHSS to an intubated patient, how should the examiner score the Dysarthria item?

Accepted Answer

Mark the item as UN (untestable) and do not penalize the patient

Answer

Dysarthria cannot be evaluated in an intubated patient. The NIHSS protocol requires marking the item as UN (untestable) in this case. UN items are not counted against the patient's score.

Question 3

For a Group B patient who has a pre-existing language barrier (speaks no English and no interpreter is available), how should the examiner approach the Language/Aphasia item?

Accepted Answer

Mark as UN (untestable) and note the language barrier

Answer

When the patient has a language barrier and no interpreter is available, the item is marked UN. The NIHSS is designed to measure neurological deficits, not language differences, so a pure language barrier without neurological cause renders the item untestable.

Question 4

A Group B patient is deeply stuporous and does not respond to voice but does withdraw to painful stimuli. How should Level of Consciousness (item 1a) be scored?

Accepted Answer

2 — Not alert and requires repeated stimulation or painful stimuli to make purposeful movements

Answer

A score of 2 is assigned when the patient is not alert and requires repeated or painful stimulation to make non-reflex (purposeful) movements. Withdrawal to pain is considered a purposeful response, distinguishing this from a score of 3.

Question 5

When scoring the Best Gaze item on a Group B patient who cannot follow verbal commands, which approach is correct?

Accepted Answer

Use oculocephalic (doll's-eye) maneuver to assess eye movement and score based on observed range of motion

Answer

The NIHSS explicitly allows the use of oculocephalic (doll's-eye) testing when a patient cannot voluntarily follow gaze commands. The examiner scores based on the range and conjugacy of eye movement observed, making the item testable even in unresponsive patients.

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NIHSS Group B Patient Examination