NIHSS Neurological 4 — Questions and Answers
Question 1: When performing NIHSS Item 6 (Motor Leg), for how many seconds must the patient hold the leg at 30 degrees?
- 5 seconds (Correct answer)
- 10 seconds
- 15 seconds
- 20 seconds
Correct answer: 5 seconds
The leg is held at 30 degrees for 5 seconds; any drift or fall within that time indicates weakness.
Question 2: A patient cannot speak but appropriately shakes their head yes/no and follows commands. What NIHSS aphasia score applies?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Score 1 reflects mild-to-moderate aphasia; the patient can communicate via alternative means despite verbal limitations.
Question 3: On NIHSS, if a patient has a prosthetic eye, how should the examiner approach Item 3 (Visual)?
- Skip the item entirely
- Test the intact eye only and score based on that eye's fields (Correct answer)
- Score 3 automatically
- Score 0 as visual testing is impossible
Correct answer: Test the intact eye only and score based on that eye's fields
Visual fields of the intact eye are tested, and the score reflects findings from that eye.
Question 4: Which NIHSS item is scored differently for patients who are intubated versus non-intubated?
- Item 1b (LOC Questions)
- Item 7 (Limb Ataxia)
- Item 9 (Dysarthria) (Correct answer)
- Item 4 (Facial Palsy)
Correct answer: Item 9 (Dysarthria)
Item 9 has a specific notation (score 3 = UN) for intubated patients who cannot be tested for dysarthria.
Question 5: A stroke patient shows right-sided facial droop affecting both upper and lower face equally. The NIHSS facial palsy score should be:
- 1
- 2
- 3 (Correct answer)
- 4
Correct answer: 3
Score 3 on facial palsy indicates complete paralysis of one or both sides of the face with no movement.
Question 6: On NIHSS Item 2 (Gaze), what finding is scored as 1?
- Normal conjugate gaze
- Partial gaze palsy (Correct answer)
- Forced deviation
- Bilateral gaze palsy
Correct answer: Partial gaze palsy
Score 1 on Item 2 reflects partial gaze palsy where gaze is abnormal but can be overcome.
Question 7: Why is limb ataxia (Item 7) scored 0 in a hemiplegic patient with obvious incoordination?
- The scale does not test upper limbs
- Ataxia is only scored if present beyond weakness (Correct answer)
- Hemiplegia automatically scores Item 7 as 0
- The item only applies to cerebellar strokes
Correct answer: Ataxia is only scored if present beyond weakness
Ataxia is only scored when it is out of proportion to weakness; if weakness prevents the task, ataxia cannot be assessed.
NIHSS Neurological 4
When performing NIHSS Item 6 (Motor Leg), for how many seconds must the patient hold the leg at 30 degrees?