NIHSS Level of Consciousness 4 — Questions and Answers
Question 1: A patient opens their eyes spontaneously, follows simple commands, but cannot state the current month correctly. Their combined NIHSS LOC score (Items 1a + 1b + 1c) would be at minimum:
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
1a=0 (alert), 1b=1 (one question wrong), 1c=0 (commands followed) = minimum total of 1 for the LOC section.
Question 2: Which NIHSS item score would NOT change if a patient transitions from stuporous to comatose between assessments?
- Item 1a
- Item 1b
- Item 1c
- All LOC items would change (Correct answer)
Correct answer: All LOC items would change
A transition from stupor (score 2 on 1a) to coma (score 3 on 1a) would also affect 1b and 1c as the patient becomes unable to respond.
Question 3: For NIHSS Item 1c, which two commands are standardly used?
- Open/close eyes and grip/release hand (Correct answer)
- Squeeze fingers and raise arm
- Stick out tongue and blink twice
- Raise both arms and shake head
Correct answer: Open/close eyes and grip/release hand
The standard NIHSS Item 1c commands are 'open and close your eyes' and 'grip and release your hand.'
Question 4: A patient with a right hemispheric stroke only responds to sternal rub and does not open their eyes to voice. NIHSS Item 1a score is:
- 0
- 1
- 2 (Correct answer)
- 3
Correct answer: 2
Requiring repeated or painful stimulation (sternal rub) to elicit any response scores a 2 on Item 1a.
Question 5: A patient correctly answers what month it is but cannot state their age. How is Item 1b scored?
- 0 - one correct is sufficient for a perfect score
- 1 - only one question answered correctly (Correct answer)
- 2 - the patient failed the primary question
- The item is deferred
Correct answer: 1 - only one question answered correctly
Answering only one of the two orientation questions correctly yields a score of 1 on Item 1b.
Question 6: During serial NIHSS assessments, a patient's Item 1a score improves from 2 to 0. This change most likely indicates:
- Worsening neurological status
- No clinically meaningful change
- Neurological improvement with return of full alertness (Correct answer)
- The examiner used a different testing method
Correct answer: Neurological improvement with return of full alertness
A decrease in Item 1a score from 2 to 0 indicates the patient has regained full alertness, suggesting neurological improvement.
Question 7: Which clinical scenario would yield a score of 2 on NIHSS Item 1b?
- Patient answers both age and month correctly
- Patient answers one of the two orientation questions correctly
- Patient cannot answer either the age or month question (Correct answer)
- Patient refuses to answer but is capable
Correct answer: Patient cannot answer either the age or month question
Failing to answer either orientation question correctly results in a score of 2 on Item 1b.
NIHSS Level of Consciousness 4
A patient opens their eyes spontaneously, follows simple commands, but cannot state the current month correctly.
Their combined NIHSS LOC score (Items 1a + 1b + 1c) would be at minimum: