NIHSS Best Gaze 2 — Questions and Answers
Question 1: A patient with acute stroke has gaze that is abnormal in one eye but the other eye moves normally. There is no forced deviation. What is the NIHSS Best Gaze score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
A score of 1 (partial gaze palsy) is assigned when gaze is abnormal in one or both eyes without forced deviation or total gaze paresis.
Question 2: Which eye movements are specifically tested in the NIHSS Best Gaze item?
- Vertical eye movements only
- Horizontal eye movements only (Correct answer)
- Both horizontal and vertical eye movements
- Convergence and divergence only
Correct answer: Horizontal eye movements only
The NIHSS Best Gaze item tests only horizontal eye movements, not vertical gaze.
Question 3: A stroke patient has a forced eye deviation to the right that cannot be overcome by the oculocephalic maneuver. What is the Best Gaze score?
- 0
- 1
- 2 (Correct answer)
- Cannot be scored
Correct answer: 2
Forced deviation or total gaze paresis not overcome by the oculocephalic maneuver scores a 2.
Question 4: When is the oculocephalic maneuver (doll's eye) permitted in NIHSS Best Gaze testing?
- Always, as the primary test
- Only in unconscious or uncooperative patients (Correct answer)
- Never; voluntary gaze is always used
- Only when the patient has a score of 0
Correct answer: Only in unconscious or uncooperative patients
The oculocephalic maneuver may be used for patients who are unconscious or otherwise unable to follow the voluntary gaze task.
Question 5: A patient following an acute stroke has a conjugate gaze deviation toward the right side and cannot move their eyes past midline to the left. The oculocephalic maneuver fails to correct this. What score is assigned?
- 0
- 1
- 2 (Correct answer)
- 3
Correct answer: 2
Total gaze paresis with failed oculocephalic override = score 2, the maximum for Best Gaze.
Question 6: A patient voluntarily looks to both sides but the examiner notices slow, slightly hypometric saccades bilaterally. No forced deviation is present. What Best Gaze score applies?
- 0
- 1 (Correct answer)
- 2
- This cannot be scored with NIHSS
Correct answer: 1
Gaze that is abnormal (slow or hypometric) in one or both eyes without forced deviation scores a 1.
Question 7: Which of the following is NOT a reason to use the oculocephalic maneuver during Best Gaze testing?
- Patient is comatose
- Patient is severely aphasic and cannot follow commands
- Patient refuses to cooperate
- Patient has normal voluntary gaze and can follow commands (Correct answer)
Correct answer: Patient has normal voluntary gaze and can follow commands
The oculocephalic maneuver is reserved for patients unable to perform voluntary gaze; it should not replace voluntary testing in cooperative patients.
NIHSS Best Gaze 2
A patient with acute stroke has gaze that is abnormal in one eye but the other eye moves normally.
There is no forced deviation.
What is the NIHSS Best Gaze score?