NIHSS Neurological 3 — Questions and Answers
Question 1: What maximum total NIHSS score indicates a very severe stroke?
- 10
- 20
- 32
- 42 (Correct answer)
Correct answer: 42
The maximum possible NIHSS score is 42, representing the most severe neurological deficits.
Question 2: During NIHSS Item 1c (Level of Consciousness Commands), the patient blinks when asked to close eyes but cannot grip. How is this scored?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Score 1 is given when the patient performs only one of the two commands correctly.
Question 3: Which NIHSS item evaluates dysarthria separately from aphasia?
- Item 8
- Item 9 (Correct answer)
- Item 10
- Item 11
Correct answer: Item 9
Item 9 specifically assesses dysarthria by asking the patient to read or repeat words.
Question 4: A patient with a brainstem stroke has bilateral limb ataxia. How does this affect NIHSS Item 7 scoring?
- Bilateral ataxia scores 2 maximum
- Each side is scored separately up to 2 (Correct answer)
- Ataxia from brainstem is excluded from scoring
- The item is not applicable and scored 0
Correct answer: Each side is scored separately up to 2
Item 7 scores limb ataxia on each side (0–1 each), with a maximum of 2 for bilateral ataxia.
Question 5: In NIHSS testing, what does a score of 3 on Item 9 (Dysarthria) indicate?
- Mute or anarthric (Correct answer)
- Mild slurring
- Severe slurring but intelligible
- Normal articulation
Correct answer: Mute or anarthric
Score 3 on dysarthria is assigned when the patient is mute or intubated and cannot be tested.
Question 6: Which condition can cause a falsely low NIHSS score despite a significant stroke?
- Large MCA territory infarct
- Right hemisphere parietal stroke with neglect
- Posterior circulation stroke affecting balance and vision only (Correct answer)
- Bilateral thalamic infarct
Correct answer: Posterior circulation stroke affecting balance and vision only
Posterior circulation strokes affecting only ataxia and visual fields may produce modest NIHSS scores despite clinical severity.
Question 7: On NIHSS Item 4 (Facial Palsy), which finding earns a score of 2?
- Normal symmetric movement
- Minor paralysis
- Partial paralysis of lower face (Correct answer)
- Complete paralysis of upper and lower face
Correct answer: Partial paralysis of lower face
Score 2 represents partial paralysis of the lower face on one side, with asymmetric movement.
NIHSS Neurological 3
What maximum total NIHSS score indicates a very severe stroke?