NIHSS Dysarthria Assessment 3 — Questions and Answers
Question 1: A stroke patient produces no intelligible sounds but is fully awake and not aphasic. What NIHSS dysarthria score is correct?
- 0
- 1
- 2 (Correct answer)
- UN
Correct answer: 2
A patient who is alert and non-aphasic but produces no intelligible speech receives a score of 2 for severe dysarthria or anarthria.
Question 2: When testing dysarthria, the examiner notices the patient speaks at a normal rate with clear articulation. The appropriate NIHSS score is:
- 0 – Normal (Correct answer)
- 1 – Mild to moderate
- 2 – Severe
- UN – Untestable
Correct answer: 0 – Normal
Clear articulation at a normal rate with no slurring earns a score of 0 (normal) on NIHSS item 10.
Question 3: Posterior circulation stroke most commonly produces dysarthria through which mechanism?
- Damage to Broca's area disrupting speech planning
- Cerebellar or brainstem lesions affecting motor speech coordination (Correct answer)
- Cortical sensory loss preventing lip movement feedback
- Frontal lobe lesion causing agrammatism
Correct answer: Cerebellar or brainstem lesions affecting motor speech coordination
Posterior circulation strokes affect the cerebellum and brainstem, directly impairing the motor coordination and cranial nerve nuclei responsible for articulation.
Question 4: During NIHSS testing, a bilingual patient speaks only Spanish and the examiner speaks only English. How should dysarthria be handled?
- Score 2 because the examiner cannot understand the patient
- Score UN because testing is not possible
- Use a translator or assess articulation quality without language content (Correct answer)
- Skip the item entirely and leave it blank
Correct answer: Use a translator or assess articulation quality without language content
A translator should be used if available; alternatively, the examiner assesses whether articulation sounds slurred regardless of language content.
Question 5: Which statement best describes the NIHSS approach to scoring dysarthria in a patient who has pre-existing slurred speech from a prior stroke?
- Score based on current speech compared with premorbid baseline if known (Correct answer)
- Always score 0 if the deficit pre-existed
- Score 2 regardless of acuity
- Skip the item and note 'chronic'
Correct answer: Score based on current speech compared with premorbid baseline if known
NIHSS scores reflect the acute neurological change; examiners compare current findings to premorbid status when a prior deficit is documented.
Question 6: Which type of dysarthria is most characteristically associated with unilateral upper motor neuron stroke affecting one side of the face and tongue?
- Ataxic dysarthria
- Spastic dysarthria (Correct answer)
- Flaccid dysarthria
- Hypokinetic dysarthria
Correct answer: Spastic dysarthria
Unilateral upper motor neuron stroke typically produces spastic dysarthria due to disrupted corticobulbar pathways controlling articulatory muscles.
Question 7: If a patient mouths words silently without producing sound (not intubated), what NIHSS dysarthria score applies?
- 0 – normal because articulators move
- 1 – mild because some movement is present
- 2 – severe or anarthric (Correct answer)
- UN – unable to test
Correct answer: 2 – severe or anarthric
Silent mouthing without vocalization in a non-intubated patient is considered severe dysarthria (anarthria) and scores a 2.
NIHSS Dysarthria Assessment 3
A stroke patient produces no intelligible sounds but is fully awake and not aphasic.
What NIHSS dysarthria score is correct?