Group A Patient Flashcards

In the Group A patient scenario, what is the maximum possible total NIHSS score that indicates the most severe stroke deficit?

Answer: 42

The maximum NIHSS total score is 42, indicating the most severe neurological deficit.

When scoring Item 1a (Level of Consciousness) for Group A patient, the patient opens eyes only to painful stimuli but makes no purposeful movements. What score applies?

Answer: 2 — not alert, requires repeated stimulation

Score 2 is assigned when the patient requires repeated stimulation or painful stimuli to make any movement and is not fully arousable.

The Group A patient has a right-sided facial palsy with complete absence of movement in the lower face but preserved forehead movement. What Item 4 score is correct?

Answer: 2 — partial paralysis of lower face

Partial paralysis (score 2) describes lower facial weakness with sparing of the forehead, consistent with an upper motor neuron lesion.

In the Group A patient assessment, the patient has cerebellar ataxia but is also hemiplegic on the same side. How should Item 7 (Limb Ataxia) be scored for the hemiplegic limb?

Answer: Score as 0 — not scored in hemiplegic limb

Limb ataxia is only scored if present and out of proportion to weakness; a paralyzed limb cannot demonstrate ataxia and is scored 0.

For Group A patient Item 2 (Best Gaze), the patient has right-sided gaze preference but can cross midline with full range on command. What is the score?

Answer: 1 — partial gaze palsy

Partial gaze palsy (score 1) applies when the patient has a gaze preference that can be overcome voluntarily or with oculocephalic maneuver.

In the Group A patient scenario, the patient correctly identifies the month but gives the wrong year when asked Item 1b questions. What is the score?

Answer: 1 — one correct

Item 1b asks for month and age specifically, not the year; if the patient answers the month correctly, one point is earned regardless of other errors.

A Group A patient cannot follow either command for Item 1c due to quadriplegia. According to NIHSS protocol, how should this be scored?

Answer: Score 2 — performs neither task

When a patient cannot perform commands due to physical inability (not cognitive failure), the score still reflects the observed response — score 2 if neither task is performed.