NIHSS Group A Patient 3 — Questions and Answers
Question 1: In a Group A patient scenario, the patient has a right homonymous hemianopia confirmed by finger counting in all quadrants. What is the Item 3 (Visual Fields) score?
- 0 — no visual loss
- 1 — partial hemianopia
- 2 — complete hemianopia (Correct answer)
- 3 — bilateral hemianopia
Correct answer: 2 — complete hemianopia
Complete hemianopia is scored as 2 when an entire half of the visual field is lost in both eyes on the same side.
Question 2: The Group A patient is asked to hold their left arm outstretched at 90 degrees (sitting). The arm drifts to 45 degrees within 10 seconds but does not touch the bed. What is Item 5a (Left Motor Arm) score?
- 0 — no drift for 10 seconds
- 1 — drift but does not hit bed (Correct answer)
- 2 — some effort against gravity
- 3 — no effort against gravity
Correct answer: 1 — drift but does not hit bed
Score 1 is given when the arm drifts from the 90-degree position but does not fall to the bed within 10 seconds.
Question 3: During Group A patient testing of Item 6 (Motor Leg), the right leg is held at 30 degrees and falls to the bed within 3 seconds. What is the Item 6b score?
- 0 — no drift for 5 seconds
- 1 — drift but does not touch bed within 5 seconds
- 2 — falls to bed within 5 seconds, some effort against gravity (Correct answer)
- 3 — immediate fall, no effort against gravity
Correct answer: 2 — falls to bed within 5 seconds, some effort against gravity
A score of 2 is given when the leg falls to the bed within 5 seconds but some initial effort against gravity was observed.
Question 4: In the Group A patient, the examiner tests Item 8 (Sensory) by applying a pin to both arms. The patient reports diminished but not absent sensation on the right side. What is the correct score?
- 0 — normal sensation
- 1 — mild to moderate sensory loss (Correct answer)
- 2 — severe or total sensory loss
- NT — not testable
Correct answer: 1 — mild to moderate sensory loss
Mild to moderate sensory loss (score 1) is recorded when the patient feels the pin but reports it as less sharp on the affected side.
Question 5: The Group A patient's speech is slurred but intelligible, and they can be understood with difficulty. What is the Item 10 (Dysarthria) score?
- 0 — normal articulation
- 1 — mild to moderate dysarthria (Correct answer)
- 2 — severe dysarthria
- NT — intubated
Correct answer: 1 — mild to moderate dysarthria
Slurred but intelligible speech that can be understood represents mild to moderate dysarthria, scored as 1.
Question 6: For Item 11 (Extinction and Inattention) in Group A patient testing, the patient consistently ignores visual stimuli on the left side when both sides are stimulated simultaneously. What is the score?
- 0 — no abnormality
- 1 — visual, tactile, auditory, or spatial inattention in one modality (Correct answer)
- 2 — profound hemi-inattention in more than one modality
- 3 — complete neglect of all stimuli
Correct answer: 1 — visual, tactile, auditory, or spatial inattention in one modality
Extinction in one sensory modality (visual) is scored as 1 on Item 11.
Question 7: A Group A patient scenario includes a patient who is intubated and cannot speak. How should Item 9 (Best Language) be scored?
- Score 0 by default
- Score 3 — mute
- Use NT (not testable) notation
- Assess by writing and gesture only and score accordingly (Correct answer)
Correct answer: Assess by writing and gesture only and score accordingly
NIHSS instructs examiners to use all available responses including writing; the score should reflect actual language function, not just speech.
NIHSS Group A Patient 3
In a Group A patient scenario, the patient has a right homonymous hemianopia confirmed by finger counting in all quadrants.
What is the Item 3 (Visual Fields) score?