NIHSS Extinction and Inattention 3

Question 1

A patient closes their eyes and the examiner touches both hands simultaneously. The patient reports only feeling the right hand being touched. On single stimulation, both hands are felt correctly. The NIHSS Item 11 score is:

Accepted Answer

1

Answer

Tactile extinction on double simultaneous stimulation with intact single-stimulus perception yields a score of 1.

Question 2

Which of the following is NOT an acceptable method of eliciting information for NIHSS Item 11?

Accepted Answer

Asking the patient to solve a mathematical problem

Answer

Mathematical problem-solving is not part of the NIHSS neglect assessment; sensory and visual simultaneous stimulation are used.

Question 3

In the context of NIHSS Item 11, what does 'inattention' refer to?

Accepted Answer

Failure to attend to one side of space without a primary sensory loss

Answer

Inattention in Item 11 means the patient neglects one hemi-space despite having intact basic sensory pathways when tested alone.

Question 4

A patient with a left MCA stroke does not look toward the right side of the room and does not respond to touch on the right arm during simultaneous bilateral stimulation, but does feel each arm individually. What is the Item 11 score?

Accepted Answer

2 — multi-modal neglect

Answer

Multi-modal neglect (visual and tactile) scores 2 regardless of which hemisphere is affected.

Question 5

Why is double simultaneous stimulation used rather than single-side stimulation in NIHSS Item 11?

Accepted Answer

It unmasks extinction that single stimulation would miss

Answer

Simultaneous bilateral stimulation creates competition between hemispheres, revealing extinction that is absent on unilateral testing.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Extinction and Inattention 3