NIHSS Score Administration and Interpretation 5

Question 1

Which of the following best describes the 'first response' rule in NIHSS scoring?

Accepted Answer

The examiner scores the patient's initial response to a stimulus without coaching

Answer

The NIHSS first-response rule requires scoring the patient's initial, uncoached response to maintain standardization.

Question 2

A patient can only partially close one eye and the nasolabial fold is slightly flattened on the right. The facial palsy score should be:

Accepted Answer

2 — partial paralysis

Answer

Partial paralysis (score 2) describes total or near-total paralysis of the lower face and incomplete closure of the upper face.

Question 3

During visual field testing (Item 3), a patient correctly identifies fingers in all quadrants. Suddenly the patient extinguishes stimuli on the left during simultaneous bilateral stimulation. How should Item 3 be scored?

Accepted Answer

1 — partial hemianopia

Answer

Extinction on double simultaneous stimulation with intact monocular fields is scored as partial hemianopia (1) on Item 3.

Question 4

In the context of serial NIHSS assessments, what does a decrease in NIHSS score of 4 or more points typically indicate?

Accepted Answer

Clinically meaningful neurological improvement

Answer

A ≥4-point decrease in NIHSS score is widely accepted as a threshold for clinically meaningful neurological improvement.

Question 5

A patient follows simple commands during LOC Commands testing (Item 1b) but only after the examiner repeats each question twice. The correct score is:

Accepted Answer

0 — correctly performed both tasks

Answer

Item 1b is scored on whether the patient correctly performs the task, not on how many repetitions were needed, so correct performance on both tasks = 0.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Score Administration and Interpretation 5