NIHSS Limb Ataxia 4

Question 1

A patient with a right cerebellar stroke scores 1 on limb ataxia (right arm ataxic only). Two hours later, re-examination shows the right leg is now also ataxic. What is the updated score?

Accepted Answer

2

Answer

With both right arm and right leg now demonstrating ataxia, the updated score is 2.

Question 2

In the NIHSS, which finger-to-nose maneuver finding specifically triggers a score of 1 rather than 0 for limb ataxia?

Accepted Answer

Definite dysmetria out of proportion to weakness

Answer

A score of 1 requires definite ataxia (dysmetria) that is out of proportion to any existing motor weakness.

Question 3

A patient with bilateral arm weakness (2/5) shows incoordination during finger-nose-finger testing. The examiner is unsure whether the incoordination is from weakness or true ataxia. What should be scored?

Accepted Answer

Score 0 — ataxia cannot be confirmed as out of proportion to weakness

Answer

When incoordination cannot be separated from weakness, the NIHSS convention is to score 0 (no confirmed ataxia).

Question 4

A 70-year-old patient with a known stroke has a prior history of Friedreich's ataxia. Limb ataxia is observed on NIHSS testing. How should the examiner handle this?

Accepted Answer

Score the ataxia normally as it is observed during testing

Answer

The NIHSS scores what is observed at examination; pre-existing conditions are noted but the item is still scored based on current findings.

Question 5

Which of the following most accurately describes the purpose of the limb ataxia item within the broader NIHSS framework?

Accepted Answer

To detect posterior circulation or cerebellar involvement in stroke

Answer

Limb ataxia on the NIHSS specifically captures cerebellar or posterior circulation dysfunction that other items may miss.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Limb Ataxia 4