NIHSS Language and Aphasia 5 — Questions and Answers
Question 1: A patient with stroke has 'word salad' speech — fluent but completely incoherent — and fails to follow any commands. What NIHSS Item 9 score applies?
- 2 — severe aphasia (Correct answer)
- 3 — mute/global
- 1 — mild aphasia
- 0 — no aphasia
Correct answer: 2 — severe aphasia
Severe aphasia with no useful communication despite fluent jargon output scores 2; score 3 is reserved for mute patients or those with global comprehension loss.
Question 2: Which artery, when occluded, classically causes Wernicke's aphasia by damaging the posterior superior temporal gyrus?
- Posterior branch of the left MCA (Correct answer)
- Anterior branch of the left MCA
- Left posterior cerebral artery
- Left anterior cerebral artery
Correct answer: Posterior branch of the left MCA
Wernicke's area (posterior superior temporal gyrus, Brodmann area 22) is supplied by the posterior division of the left middle cerebral artery.
Question 3: When the NIHSS examiner reads a sentence and asks the patient to repeat it, which specific language function is being primarily tested?
- Auditory processing and verbal output pathway integrity (Correct answer)
- Reading comprehension and visual processing
- Spontaneous narrative ability
- Word retrieval from long-term memory
Correct answer: Auditory processing and verbal output pathway integrity
Repetition tasks test the perisylvian language network, including auditory input (Wernicke's), the arcuate fasciculus, and verbal output (Broca's).
Question 4: A bilingual patient who speaks English and Spanish suffers a stroke. During the NIHSS, she cannot speak English but family reports she occasionally speaks Spanish. How should Item 9 be scored?
- Score based on the best language performance observed in either language (Correct answer)
- Score 3 because she cannot perform the English tasks
- Score 0 because she can communicate in Spanish
- Skip the item as untestable due to language barrier
Correct answer: Score based on the best language performance observed in either language
NIHSS instructions indicate the examiner should score the best performance the patient can achieve, including in a second language or using an interpreter.
Question 5: Which finding on NIHSS language assessment most strongly suggests Broca's aphasia rather than global aphasia?
- Preserved ability to follow simple commands (Correct answer)
- Complete absence of any verbal output
- Fluent paraphasic speech with jargon
- No response to verbal or written stimuli
Correct answer: Preserved ability to follow simple commands
In Broca's aphasia, auditory comprehension is relatively preserved, so patients can follow simple commands despite severely non-fluent speech output.
Question 6: A patient naming objects on the NIHSS card calls a 'feather' a 'thing for writing' instead. This circumlocution indicates:
- Anomia with preserved semantic knowledge (Correct answer)
- Phonemic paraphasia
- Pure alexia
- Dysarthria
Correct answer: Anomia with preserved semantic knowledge
Circumlocution — describing a word's function rather than stating the word — reflects anomia while showing the patient retains the concept but cannot retrieve its name.
Question 7: In the NIHSS standardized sentence reading card, one of the phrases is 'You know how.' What aspect of language does reading this sentence aloud primarily assess?
- Reading aloud, combining visual decoding and verbal output (Correct answer)
- Auditory comprehension and repetition
- Object naming from visual recognition
- Spontaneous narrative generation
Correct answer: Reading aloud, combining visual decoding and verbal output
Reading aloud tests grapheme-to-phoneme conversion plus motor speech output, helping identify alexia with or without dysfluency alongside aphasia.
NIHSS Language and Aphasia 5
A patient with stroke has 'word salad' speech — fluent but completely incoherent — and fails to follow any commands.
What NIHSS Item 9 score applies?