NIHSS Group A Patient 4 — Questions and Answers
Question 1: In the Group A patient scenario, what is the maximum possible total NIHSS score that indicates the most severe stroke deficit?
- 21
- 30
- 42 (Correct answer)
- 56
Correct answer: 42
The maximum NIHSS total score is 42, indicating the most severe neurological deficit.
Question 2: When scoring Item 1a (Level of Consciousness) for Group A patient, the patient opens eyes only to painful stimuli but makes no purposeful movements. What score applies?
- 0 — alert, keenly responsive
- 1 — not alert, but arousable by minor stimulation
- 2 — not alert, requires repeated stimulation (Correct answer)
- 3 — responds only with reflex or totally unresponsive
Correct answer: 2 — not alert, requires repeated stimulation
Score 2 is assigned when the patient requires repeated stimulation or painful stimuli to make any movement and is not fully arousable.
Question 3: The Group A patient has a right-sided facial palsy with complete absence of movement in the lower face but preserved forehead movement. What Item 4 score is correct?
- 1 — minor paralysis
- 2 — partial paralysis of lower face (Correct answer)
- 3 — complete paralysis of one or both sides
- 0 — normal
Correct answer: 2 — partial paralysis of lower face
Partial paralysis (score 2) describes lower facial weakness with sparing of the forehead, consistent with an upper motor neuron lesion.
Question 4: In the Group A patient assessment, the patient has cerebellar ataxia but is also hemiplegic on the same side. How should Item 7 (Limb Ataxia) be scored for the hemiplegic limb?
- Score based on the ataxia observed
- Score as 0 — not scored in hemiplegic limb (Correct answer)
- Score as NT — not testable
- Score as 2 — both limbs affected
Correct answer: Score as 0 — not scored in hemiplegic limb
Limb ataxia is only scored if present and out of proportion to weakness; a paralyzed limb cannot demonstrate ataxia and is scored 0.
Question 5: For Group A patient Item 2 (Best Gaze), the patient has right-sided gaze preference but can cross midline with full range on command. What is the score?
- 0 — normal
- 1 — partial gaze palsy (Correct answer)
- 2 — forced deviation
- NT — not testable
Correct answer: 1 — partial gaze palsy
Partial gaze palsy (score 1) applies when the patient has a gaze preference that can be overcome voluntarily or with oculocephalic maneuver.
Question 6: In the Group A patient scenario, the patient correctly identifies the month but gives the wrong year when asked Item 1b questions. What is the score?
- 0 — both correct
- 1 — one correct (Correct answer)
- 2 — neither correct
- NT — aphasic patient
Correct answer: 1 — one correct
Item 1b asks for month and age specifically, not the year; if the patient answers the month correctly, one point is earned regardless of other errors.
Question 7: A Group A patient cannot follow either command for Item 1c due to quadriplegia. According to NIHSS protocol, how should this be scored?
- Score 2 — performs neither task (Correct answer)
- Score NT — not testable
- Score 1 — partial credit given
- Score 0 — physical inability is not counted
Correct answer: Score 2 — performs neither task
When a patient cannot perform commands due to physical inability (not cognitive failure), the score still reflects the observed response — score 2 if neither task is performed.
NIHSS Group A Patient 4
In the Group A patient scenario, what is the maximum possible total NIHSS score that indicates the most severe stroke deficit?