NIHSS Limb Ataxia 5 — Questions and Answers
Question 1: A patient presents with acute vertigo, ipsilateral facial numbness, and right arm ataxia after a lateral medullary infarct. What NIHSS limb ataxia score would be expected?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Wallenberg (lateral medullary) syndrome typically causes ipsilateral limb ataxia in one limb, scoring 1.
Question 2: Which of the following patient presentations is MOST consistent with an NIHSS limb ataxia score of 0?
- Patient with right arm dysmetria and right leg heel-shin incoordination
- Patient with bilateral leg ataxia after bilateral PICA infarcts
- Patient with a pure motor lacunar infarct and no coordination deficits on testing (Correct answer)
- Patient with AICA infarct and ipsilateral arm ataxia
Correct answer: Patient with a pure motor lacunar infarct and no coordination deficits on testing
A pure motor lacunar infarct involves the corticospinal tract, not the cerebellum, so coordination testing would be normal (score 0).
Question 3: In a patient with intact strength but significant intention tremor during finger-nose-finger testing, what NIHSS limb ataxia score applies?
- 0 — intention tremor is not scored as ataxia
- 1 — ataxia present in one limb (Correct answer)
- 2 — bilateral ataxia assumed from intention tremor
- UN — tremor makes scoring unreliable
Correct answer: 1 — ataxia present in one limb
Intention tremor during the finger-nose-finger test in the presence of normal strength reflects cerebellar ataxia and scores 1 for that limb.
Question 4: A patient's NIHSS is being administered remotely via telemedicine. The patient is asked to perform finger-nose-finger testing on camera. Which statement about scoring limb ataxia is most accurate?
- Limb ataxia cannot be scored via telemedicine under any circumstance
- Limb ataxia can be scored if the examiner can clearly observe the movement on camera (Correct answer)
- Limb ataxia should always default to 0 in telemedicine settings
- Only lower-limb ataxia is valid via telemedicine
Correct answer: Limb ataxia can be scored if the examiner can clearly observe the movement on camera
Telemedicine NIHSS can include limb ataxia assessment when camera quality allows clear visualization of the movement.
Question 5: A patient performs heel-to-shin testing with the right leg smoothly but shows gross dysmetria with the left leg despite only mild left leg weakness (4/5). What is the limb ataxia score?
- 0
- 1 (Correct answer)
- 2
- UN for the left leg
Correct answer: 1
Left leg dysmetria is clearly out of proportion to the mild (4/5) weakness, confirming ataxia in one limb — score 1.
Question 6: Which imaging finding is most commonly associated with an NIHSS limb ataxia score of 2 in acute stroke?
- Bilateral basal ganglia infarcts
- Bilateral cerebellar or brainstem infarcts affecting both sides (Correct answer)
- Large cortical MCA territory infarct
- Bilateral thalamic infarcts
Correct answer: Bilateral cerebellar or brainstem infarcts affecting both sides
Bilateral cerebellar or brainstem infarcts disrupt coordination bilaterally, producing ataxia in two or more limbs (score 2).
Question 7: Why is the NIHSS limb ataxia item considered to have limited sensitivity for detecting all cerebellar infarcts?
- Because it only tests upper limbs
- Because small cerebellar infarcts may not produce detectable ataxia on bedside testing (Correct answer)
- Because the scoring scale goes up to 4, under-representing findings
- Because it is only administered once and not repeated
Correct answer: Because small cerebellar infarcts may not produce detectable ataxia on bedside testing
Small or compensated cerebellar infarcts may produce no observable ataxia at bedside, so the NIHSS limb ataxia item can miss subtle posterior circulation strokes.
NIHSS Limb Ataxia 5
A patient presents with acute vertigo, ipsilateral facial numbness, and right arm ataxia after a lateral medullary infarct.
What NIHSS limb ataxia score would be expected?