NIHSS Dysarthria Assessment 5 — Questions and Answers
Question 1: A patient scores 0 on NIHSS best language (item 9) but 1 on dysarthria (item 10). What does this combination indicate?
- The patient has expressive aphasia without motor problems
- The patient has intact language content but impaired motor articulation (Correct answer)
- Both scores are invalid and should be retested
- The patient likely has cerebellar ataxia affecting cognition
Correct answer: The patient has intact language content but impaired motor articulation
Normal language with mild dysarthria indicates intact linguistic processing but disrupted corticobulbar or cerebellar motor speech pathways.
Question 2: A patient has facial droop (NIHSS item 4 = 2) but no dysarthria. This is best explained by:
- Dysarthria and facial droop always co-occur in stroke
- Facial droop affects perioral muscles differently than the articulators needed for intelligible speech
- The examiner likely made an error on one of the items
- Bilateral facial innervation fully compensates for unilateral droop during speech (Correct answer)
Correct answer: Bilateral facial innervation fully compensates for unilateral droop during speech
The lower face has predominantly contralateral cortical innervation, but the muscles critical for speech receive enough bilateral cortical input to maintain intelligibility despite unilateral droop.
Question 3: In the context of the NIHSS, 'mild to moderate dysarthria' (score 1) is defined as speech that is:
- Completely unintelligible despite best effort
- Slurred but the patient can be understood (Correct answer)
- Normal with only slight voice quality change
- Absent due to intubation
Correct answer: Slurred but the patient can be understood
NIHSS score 1 for dysarthria is explicitly defined as slurred but understandable speech — the patient is intelligible though articulation is abnormal.
Question 4: Which scenario represents correct NIHSS dysarthria scoring after tPA administration?
- Dysarthria is not re-scored after tPA because it reflects structural damage
- Dysarthria is re-scored at 2 hours and 24 hours as part of serial NIHSS assessment (Correct answer)
- Only the aphasia item is re-scored post-tPA
- Dysarthria is re-scored only if the patient deteriorates
Correct answer: Dysarthria is re-scored at 2 hours and 24 hours as part of serial NIHSS assessment
Serial NIHSS assessments at 2 and 24 hours post-tPA include all items including dysarthria to track treatment response and detect complications.
Question 5: A patient with known Parkinson's disease has hypophonic, mildly slurred speech at baseline. During acute stroke workup, the NIHSS dysarthria score should reflect:
- Always score 0 because Parkinson's dysarthria is chronic
- Score based on the acute change from the patient's documented Parkinson's baseline (Correct answer)
- Always score 2 to be conservative
- Skip the item and note Parkinson's disease
Correct answer: Score based on the acute change from the patient's documented Parkinson's baseline
NIHSS measures acute neurological change; if a Parkinson's baseline is known, the examiner scores the acute increment beyond that baseline.
Question 6: Which phrase from the standard NIHSS word list specifically tests lingual (tongue) articulation?
- 'Mama'
- 'Tip-top'
- 'Fifty-fifty'
- 'Huckleberry' (Correct answer)
Correct answer: 'Huckleberry'
'Huckleberry' is on the NIHSS word list and requires complex lingual movements, making it sensitive to tongue weakness or incoordination from stroke.
Question 7: A patient being evaluated for posterior circulation stroke has scanning speech with irregular rhythm and explosive consonants. This pattern is most consistent with:
- Spastic dysarthria from bilateral corticobulbar damage
- Ataxic dysarthria from cerebellar involvement (Correct answer)
- Flaccid dysarthria from lower motor neuron damage
- Hypokinetic dysarthria from basal ganglia lesion
Correct answer: Ataxic dysarthria from cerebellar involvement
Scanning speech — irregular rhythm, equal stress, and explosive consonants — is the hallmark of ataxic dysarthria caused by cerebellar stroke.
NIHSS Dysarthria Assessment 5
A patient scores 0 on NIHSS best language (item 9) but 1 on dysarthria (item 10).
What does this combination indicate?