Visual Field Testing Flashcards

A patient has bilateral occipital lobe infarcts from a basilar artery stroke. They are cortically blind but deny being blind (Anton syndrome). How should NIHSS item 3 be scored?

Answer: 3, because bilateral blindness is present regardless of denial

Objective findings of bilateral blindness are scored 3 even if the patient denies the deficit due to anosognosia (Anton syndrome).

The NIHSS specifies that visual fields should be tested by confrontation using finger counting or visual threat. What is the rationale for allowing visual threat as an alternative?

Answer: It allows testing in aphasic or unresponsive patients who cannot report seeing fingers

Visual threat allows assessment of grossly intact vs. absent visual fields in patients who are unable to verbally or motorically respond to finger counting.

A patient with a right posterior cerebral artery infarct demonstrates left homonymous hemianopia plus macular sparing. How should NIHSS item 3 be scored?

Answer: 2 — complete hemianopia

Even with macular sparing, a complete left homonymous hemianopia meets criteria for NIHSS score 2 (complete hemianopia).

When documenting the NIHSS visual field result in a clinical note, the examiner writes 'VF: 1 (partial loss — right superior quadrantanopia)'. What does this notation correctly convey?

Answer: The patient has an incomplete field defect limited to one quadrant

A right superior quadrantanopia is an incomplete (partial) field loss restricted to one quadrant, appropriately scored as 1.

A patient has monocular vision loss in the right eye from a central retinal artery occlusion that occurred one week before the current stroke. Visual fields in the left eye are full. What is the NIHSS item 3 score for the current stroke?

Answer: 0 — prior baseline

The monocular loss is a pre-existing condition unrelated to the acute stroke and is not attributed to the current event; baseline deficits do not contribute to the stroke score.

How many total score points can be contributed by NIHSS item 3 (Visual) to the overall NIHSS score?

Answer: Up to 3 points

NIHSS item 3 is scored 0–3, so it can contribute a maximum of 3 points to the total NIHSS score.

A clinician is performing NIHSS serial assessments on a patient at 0, 2, and 24 hours post-stroke. On day 1, item 3 was scored 2 (complete hemianopia). At 24 hours the hemianopia has partially resolved to a quadrantanopia. What is the updated score?

Answer: 1 — partial loss reflecting improvement

The NIHSS reflects the current neurological status at the time of testing; improvement to a quadrantanopia is recorded as 1.