NIHSS Language and Aphasia 4 — Questions and Answers
Question 1: Which of the following tasks is NOT included in the standard NIHSS language assessment (Item 9)?
- Repeating a tongue-twister sentence rapidly (Correct answer)
- Describing the cookie theft picture
- Naming objects on a card
- Reading sentences aloud from a card
Correct answer: Repeating a tongue-twister sentence rapidly
Rapid repetition for tongue twisters tests dysarthria (Item 10), not language (Item 9); the language item uses picture description, naming, and sentence reading.
Question 2: A patient with Wernicke's aphasia asks 'what do you want me to do?' after being asked to lift their arm. Which NIHSS item does this primarily affect?
- Item 9 — Language (comprehension failure) (Correct answer)
- Item 4 — Facial palsy
- Item 6 — Motor arm (failure to follow command)
- Item 11 — Extinction and inattention
Correct answer: Item 9 — Language (comprehension failure)
The inability to understand verbal commands reflects receptive aphasia and would raise the NIHSS Item 9 language score, not just the motor item.
Question 3: A patient says 'pen' correctly, then calls a comb a 'pen' as well. This error is best classified as:
- Perseveration (Correct answer)
- Semantic paraphasia
- Phonemic paraphasia
- Neologism
Correct answer: Perseveration
Perseveration occurs when a patient inappropriately repeats a previous response for a new stimulus, a common error in aphasia assessment.
Question 4: In NIHSS scoring, if a patient has mild word-finding difficulty but communication is still possible, the correct Item 9 score is:
- 1 (Correct answer)
- 0
- 2
- 3
Correct answer: 1
Mild to moderate aphasia that still allows some communication corresponds to a score of 1 on NIHSS Item 9.
Question 5: Which right-hemisphere stroke finding can be mistaken for language impairment during NIHSS assessment?
- Left hemispatial neglect causing the patient to ignore left-side pictures (Correct answer)
- Right facial droop causing dysarthria
- Right arm weakness limiting written responses
- Right visual field cut limiting reading
Correct answer: Left hemispatial neglect causing the patient to ignore left-side pictures
Left hemispatial neglect from right hemisphere stroke may cause the patient to miss left-side elements of the naming or picture card, mimicking language errors.
Question 6: Transcortical motor aphasia is characterized by which pattern most relevant to NIHSS Item 9?
- Intact repetition but reduced spontaneous speech (Correct answer)
- Fluent paraphasic output with impaired repetition
- Total absence of speech and comprehension
- Normal speech with severely impaired comprehension
Correct answer: Intact repetition but reduced spontaneous speech
Transcortical motor aphasia features non-fluent spontaneous speech but preserved repetition because Broca's area connections to Wernicke's remain intact.
Question 7: When scoring NIHSS Item 9, which of the following patient behaviors would most likely result in a score of 2?
- Patient speaks in jargon and cannot follow any verbal instructions (Correct answer)
- Patient correctly names 4 of 6 objects with mild hesitation
- Patient reads sentences haltingly but with full accuracy
- Patient answers yes/no questions reliably but cannot name objects
Correct answer: Patient speaks in jargon and cannot follow any verbal instructions
Jargon speech with absent comprehension represents severe aphasia where no useful information exchange occurs, warranting a score of 2.
NIHSS Language and Aphasia 4
Which of the following tasks is NOT included in the standard NIHSS language assessment (Item 9)?