NIHSS Extinction and Inattention 4 — Questions and Answers
Question 1: Anosognosia, the unawareness of one's own neurological deficit, is BEST captured under which NIHSS item?
- Item 1a — Level of Consciousness
- Item 9 — Best Language
- Item 11 — Extinction and Inattention (Correct answer)
- Item 6 — Motor Arm
Correct answer: Item 11 — Extinction and Inattention
Anosognosia represents a form of inattention to one's own body or deficit and is captured under NIHSS Item 11.
Question 2: A patient consistently neglects the left side of space visually and does not respond to left-sided touch during simultaneous stimulation, but when shown a bright light on the left alone, notices it. The NIHSS Item 11 score is:
- 0
- 1
- 2 (Correct answer)
- Cannot be determined
Correct answer: 2
Multi-modal extinction (visual + tactile) on simultaneous stimulation despite preserved single-sided perception scores 2.
Question 3: A nurse documents that a patient 'dresses only the right side of the body and only eats food on the right side of the plate.' These behaviors MOST directly suggest:
- Apraxia
- Hemispatial neglect scoring 2 on Item 11 (Correct answer)
- Homonymous hemianopia scoring on Item 3
- Sensory loss scoring on Item 8
Correct answer: Hemispatial neglect scoring 2 on Item 11
Unilateral dressing and eating neglect are classic functional manifestations of hemispatial neglect assessed by NIHSS Item 11.
Question 4: Which pairing of neurological deficit and NIHSS Item 11 score is INCORRECT?
- Tactile extinction only → 1
- Visual extinction only → 1
- Tactile and visual extinction → 2
- No extinction or neglect → 1 (Correct answer)
Correct answer: No extinction or neglect → 1
No extinction or neglect should score 0, not 1; a score of 1 requires at least one modality showing inattention.
Question 5: During NIHSS testing, the examiner wiggles fingers simultaneously in both visual fields. The patient with a large right hemisphere stroke consistently looks only to the right. This represents:
- Gaze deviation scored under Item 2
- Visual extinction scored under Item 11 (Correct answer)
- Hemianopia scored under Item 3
- Both gaze deviation and visual neglect, affecting Items 2 and 11
Correct answer: Visual extinction scored under Item 11
Consistently attending only to the ipsilesional side during bilateral visual stimulation indicates visual extinction/neglect scored under Item 11.
Question 6: A patient has left-sided tactile extinction but no visual neglect. The examiner also notes the patient is unaware of his left arm weakness. What is the minimum Item 11 score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
At least one modality affected (tactile extinction) scores 1; anosognosia alone in a single domain also maps to score 1.
Question 7: Compared to hemianopia (Item 3), visual extinction in Item 11 differs because:
- Hemianopia affects central vision; extinction affects peripheral vision
- Extinction is present on single-sided testing; hemianopia requires bilateral testing
- In extinction, vision is intact on single-sided testing but lost on simultaneous bilateral testing (Correct answer)
- Hemianopia is always worse than extinction
Correct answer: In extinction, vision is intact on single-sided testing but lost on simultaneous bilateral testing
The hallmark of extinction is preserved single-sided visual field on individual testing, with failure only under simultaneous bilateral stimulation.
NIHSS Extinction and Inattention 4
Anosognosia, the unawareness of one's own neurological deficit, is BEST captured under which NIHSS item?