NIHSS Best Gaze 4

Question 1

An examiner asks a stroke patient to follow a finger moving to the far right and then far left. The patient's left eye stops at midline while the right eye reaches full lateral gaze. No forced deviation is present. What Best Gaze score applies?

Accepted Answer

1 — partial gaze palsy present

Answer

When gaze is abnormal in one or both eyes but forced deviation is absent, the score is 1 (partial gaze palsy).

Question 2

Which of the following best describes an internuclear ophthalmoplegia (INO) and its NIHSS Best Gaze score?

Accepted Answer

Impaired adduction of one eye on lateral gaze; scores 1

Answer

INO causes impaired adduction of the ipsilateral eye on lateral gaze, representing a partial gaze abnormality that scores 1.

Question 3

The NIHSS Best Gaze item is scored ONLY on:

Accepted Answer

The patient's best attempt after repeated trials

Answer

NIHSS principles direct the examiner to score the patient's best performance on the tested item.

Question 4

A patient with acute stroke has eyes deviated to the left, but with vigorous oculocephalic stimulation the eyes briefly cross midline to the right before returning to the deviated position. What is the Best Gaze score?

Accepted Answer

1

Answer

If the forced deviation can be partially or fully overcome by the oculocephalic maneuver, the score is 1, not 2.

Question 5

A clinician is testing Best Gaze in a patient with known bilateral blindness. Which technique should be used?

Accepted Answer

Test voluntary horizontal gaze using command ('look left/right') without a visual target

Answer

Blind patients can still perform voluntary horizontal gaze on verbal command, so the item remains testable without a visual target.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Best Gaze 4