NIHSS Extinction and Inattention 5 — Questions and Answers
Question 1: A patient's NIHSS Item 11 score changes from 2 to 1 over 24 hours. This change MOST likely indicates:
- Worsening stroke
- Improvement from multi-modal to single-modality neglect (Correct answer)
- The examiner scored incorrectly the first time
- The patient is now comatose
Correct answer: Improvement from multi-modal to single-modality neglect
A decrease from 2 to 1 indicates the patient's neglect has improved from multiple modalities to only one, reflecting neurological recovery.
Question 2: Which of the following clinical pearls is TRUE regarding NIHSS Item 11 in acute stroke?
- Neglect is equally common after left and right hemisphere strokes
- Right hemisphere strokes produce more severe and persistent neglect than left hemisphere strokes (Correct answer)
- Neglect always resolves within 24 hours of stroke onset
- Neglect can only be assessed in alert, cooperative patients
Correct answer: Right hemisphere strokes produce more severe and persistent neglect than left hemisphere strokes
Right hemisphere lesions produce more severe and durable hemispatial neglect because the right hemisphere subserves bilateral spatial attention.
Question 3: When scoring NIHSS Item 11, the examiner should use information from:
- Only standardized double simultaneous stimulation tests
- Only family or nursing reports of neglect behavior
- Both the formal double simultaneous stimulation test and behavioral observations during the exam (Correct answer)
- MRI findings showing parietal involvement
Correct answer: Both the formal double simultaneous stimulation test and behavioral observations during the exam
NIHSS Item 11 incorporates both formal stimulation testing and behavioral cues observed throughout the examination.
Question 4: A patient with global aphasia is tested for Item 11. The examiner touches both hands; the patient consistently withdraws only the right hand and orients toward the right. The appropriate score is:
- 0 — cannot assess due to aphasia
- 1 — possible extinction in one modality (Correct answer)
- 2 — behavioral evidence suggests multi-modal neglect
- Deferred until language returns
Correct answer: 1 — possible extinction in one modality
Consistent behavioral responses (withdrawal and orienting) allow scoring; one modality with apparent extinction scores 1.
Question 5: What is the maximum contribution of NIHSS Item 11 to the total NIHSS score?
- 1 point
- 2 points (Correct answer)
- 3 points
- 4 points
Correct answer: 2 points
Item 11 is scored 0–2, so its maximum contribution to the total NIHSS score is 2 points.
Question 6: A patient reports that both hands are touched when only the right hand is stimulated. This phenomenon is called:
- Allodynia
- Allochiria (Correct answer)
- Paresthesia
- Dysesthesia
Correct answer: Allochiria
Allochiria is the misreferral of a stimulus from one side to the other, a form of spatial disorientation related to neglect.
Question 7: A patient with a posterior right hemisphere stroke can name objects in both visual fields individually but misses the left-field object every time during simultaneous presentation, and also fails to feel the left hand when both are touched. This patient's Item 11 score and the MOST likely score impact on total NIHSS is:
- Score 1; adds 1 point to total
- Score 2; adds 2 points to total (Correct answer)
- Score 0; adds nothing to total
- Score 2; adds 4 points to total
Correct answer: Score 2; adds 2 points to total
Multi-modal extinction (visual + tactile) scores 2, contributing exactly 2 points to the total NIHSS.
NIHSS Extinction and Inattention 5
A patient's NIHSS Item 11 score changes from 2 to 1 over 24 hours.
This change MOST likely indicates: