NIHSS Facial Palsy 3

Question 1

A patient after a lacunar infarct shows only slight asymmetry of the nasolabial fold at rest but symmetric smiling. What NIHSS Facial Palsy score is assigned?

Accepted Answer

1 – Minor paralysis

Answer

A minor resting nasolabial fold asymmetry without functional loss during smiling corresponds to a score of 1.

Question 2

Bilateral complete facial paralysis on the NIHSS Facial Palsy item would be scored as:

Accepted Answer

3

Answer

A score of 3 applies whether the complete palsy is unilateral or bilateral, as per NIHSS scoring conventions.

Question 3

Which instruction is MOST appropriate when asking a cooperative patient to demonstrate facial function for NIHSS item 4?

Accepted Answer

'Show me your teeth or raise your eyebrows'

Answer

Asking the patient to show teeth or raise eyebrows directly tests voluntary facial movement in upper and lower distributions.

Question 4

A patient demonstrates asymmetric eye closure: the left eye does not fully close during sleep or volitional effort, and the left lower face is completely flaccid. This pattern is most consistent with:

Accepted Answer

Peripheral (LMN) facial palsy, NIHSS score 3

Answer

Inability to close the eye combined with lower facial flaccidity indicates peripheral (LMN) facial nerve palsy, scored 3 on NIHSS.

Question 5

On the NIHSS, when is it acceptable to score Facial Palsy as 'untestable' (NT)?

Accepted Answer

When facial trauma or bandaging prevents assessment

Answer

Physical obstruction such as facial trauma, dressings, or orotracheal tape that prevents visualization is a valid reason to score NT.

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NIHSS Facial Palsy 3