NIHSS Score Administration and Interpretation 4 — Questions and Answers
Question 1: A patient with a known language barrier due to being non-English-speaking cannot follow verbal commands during NIHSS testing. How should the examiner proceed?
- Skip the language item and score it as 0
- Use pantomime and visual cues as permitted by the protocol (Correct answer)
- Ask a family member to translate all commands
- Document 'unable to test' and omit the item from the total score
Correct answer: Use pantomime and visual cues as permitted by the protocol
The NIHSS allows pantomime and visual cues for language-related items when a language barrier exists, and the examiner must score based on observed responses.
Question 2: Which NIHSS item specifically evaluates the patient's ability to name objects and read sentences?
- Dysarthria (Item 10)
- Best Language (Item 9) (Correct answer)
- Level of Consciousness Commands (Item 1b)
- Extinction and Inattention (Item 11)
Correct answer: Best Language (Item 9)
Best Language (Item 9) assesses naming, reading, and comprehension to evaluate aphasia severity.
Question 3: A patient scores 2 on facial palsy, 2 on left arm motor, 2 on left leg motor, 1 on sensory, and 1 on best language. What is the total NIHSS score?
- 6
- 7
- 8 (Correct answer)
- 9
Correct answer: 8
2+2+2+1+1 = 8; accurate addition across items is essential for correct severity classification.
Question 4: During the limb ataxia item, the examiner notes the patient cannot move her arm due to paralysis. The correct score is:
- 1 — ataxia present in one limb
- 2 — ataxia present in both limbs
- 0 — scored as absent because weakness explains the finding (Correct answer)
- UN — untestable due to paralysis
Correct answer: 0 — scored as absent because weakness explains the finding
Limb ataxia is scored 0 (absent) when weakness or paralysis is sufficient to explain the incoordination, per NIHSS protocol.
Question 5: An NIHSS score of 16–20 is categorized as:
- Minor stroke
- Moderate-to-severe stroke (Correct answer)
- Moderate stroke
- Severe stroke
Correct answer: Moderate-to-severe stroke
Scores of 16–20 fall in the moderate-to-severe range, indicating significant neurological deficit requiring aggressive management.
Question 6: Why is it critical that NIHSS examiners refrain from coaching or providing feedback during the assessment?
- Feedback can cause the patient emotional distress
- Coaching can artificially inflate scores and misrepresent deficits (Correct answer)
- Coaching can lead to lower scores by confusing the patient
- Feedback is only allowed for pediatric patients
Correct answer: Coaching can artificially inflate scores and misrepresent deficits
Coaching or cueing can produce better-than-actual performance, inflating scores and masking true deficits that affect treatment decisions.
Question 7: A patient who is intubated and cannot speak is being assessed for dysarthria (Item 10). The correct action is:
- Score 0 since there is no evidence of slurred speech
- Score 2 for severe dysarthria
- Score 1 for mild dysarthria
- Mark as UN (untestable) and do not include in total (Correct answer)
Correct answer: Mark as UN (untestable) and do not include in total
Dysarthria in an intubated patient is marked UN (untestable) because the mechanical impediment prevents valid assessment.
NIHSS Score Administration and Interpretation 4
A patient with a known language barrier due to being non-English-speaking cannot follow verbal commands during NIHSS testing.
How should the examiner proceed?