NIHSS Extinction and Inattention 2 — Questions and Answers
Question 1: A patient with a right hemisphere stroke ignores food on the left side of the tray and fails to respond to touch on the left arm when both arms are touched simultaneously. What NIHSS Item 11 score applies?
- 0 — no abnormality
- 1 — inattention or extinction in one modality
- 2 — profound hemi-inattention in more than one modality (Correct answer)
- 3 — complete neglect of both sides
Correct answer: 2 — profound hemi-inattention in more than one modality
Neglect involving more than one sensory modality (visual and tactile here) scores 2 on NIHSS Item 11.
Question 2: Which term best describes the phenomenon where a patient consistently fails to recognize or respond to stimuli on one side of space?
- Aphasia
- Hemispatial neglect (Correct answer)
- Ataxia
- Dysarthria
Correct answer: Hemispatial neglect
Hemispatial neglect is the clinical term for failing to attend to one side of space, assessed by NIHSS Item 11.
Question 3: During double simultaneous stimulation of the visual fields, the patient correctly identifies a finger wiggled on the right but consistently misses one wiggled on the left. The patient has no visual field cut on single presentation. This is:
- Normal finding; score 0
- Visual extinction; score 1 (Correct answer)
- Complete hemianopia; score 2
- Cortical blindness; score 0
Correct answer: Visual extinction; score 1
Extinction to double simultaneous visual stimulation with intact single-stimulus perception scores 1 on Item 11.
Question 4: A stroke patient can identify objects placed in either hand alone but when objects are placed in both hands simultaneously always identifies only the right-hand object. Which modality demonstrates extinction?
- Visual
- Auditory
- Tactile (Correct answer)
- Proprioceptive
Correct answer: Tactile
Failure to perceive simultaneous tactile stimuli on one side while perceiving each side alone indicates tactile extinction.
Question 5: NIHSS Item 11 awards a score of 1 when:
- The patient is completely unresponsive to all stimuli on one side
- Visual, tactile, and auditory neglect are all present simultaneously
- Inattention or extinction is present in only one sensory modality (Correct answer)
- The patient cannot identify fingers on either side
Correct answer: Inattention or extinction is present in only one sensory modality
A score of 1 reflects mild neglect limited to a single modality such as visual or tactile extinction.
Question 6: When evaluating a patient who cannot speak or has severe comprehension deficits, how should the examiner assess Item 11?
- Skip the item and assign a score of 0
- Use double simultaneous visual and tactile stimulation and observe behavioral responses (Correct answer)
- Ask the patient to describe what they see in writing
- Score automatically as 2 due to communication barriers
Correct answer: Use double simultaneous visual and tactile stimulation and observe behavioral responses
Behavioral observation during simultaneous stimulation allows assessment of neglect even in aphasic or poorly cooperative patients.
Question 7: A patient with NIHSS Item 11 scored as 2 most likely has a lesion in which brain region?
- Cerebellum
- Brainstem (pons)
- Right parietal cortex (Correct answer)
- Left frontal operculum
Correct answer: Right parietal cortex
Severe hemispatial neglect with multi-modal extinction is classically associated with right parietal cortex damage.
NIHSS Extinction and Inattention 2
A patient with a right hemisphere stroke ignores food on the left side of the tray and fails to respond to touch on the left arm when both arms are touched simultaneously.
What NIHSS Item 11 score applies?