NIHSS Sensory Testing 2 — Questions and Answers
Question 1: A patient with a brainstem stroke has decreased sensation on both sides of the body. How should NIHSS Item 8 be scored?
- Score 0 because bilateral findings cancel out
- Score 1 because bilateral loss is possible in brainstem strokes
- Score 2 because severe bilateral sensory loss applies (Correct answer)
- The item cannot be scored in brainstem strokes
Correct answer: Score 2 because severe bilateral sensory loss applies
Bilateral sensory loss from brainstem stroke scores 2 (severe to total sensory loss) because the patient cannot feel pinprick on both sides.
Question 2: When performing NIHSS sensory testing, which tool is the standard stimulus used to assess sensation?
- Cotton wisp
- Tuning fork
- Pinprick or broken wooden applicator (Correct answer)
- Monofilament
Correct answer: Pinprick or broken wooden applicator
A pinprick or the sharp end of a broken wooden applicator stick is the standard stimulus for NIHSS sensory testing.
Question 3: A comatose patient cannot respond to any sensory stimulation. What NIHSS Item 8 score is assigned?
- 0 — cannot assess, default to normal
- 1 — unresponsive patients default to mild loss
- 2 — no response indicates severe/total sensory loss (Correct answer)
- The item is skipped and marked untestable
Correct answer: 2 — no response indicates severe/total sensory loss
A comatose patient who shows no response to noxious stimulation is scored 2 for severe to total sensory loss.
Question 4: During sensory testing, a patient reports feeling the pinprick less sharply on the right arm compared to the left. The right face and leg feel equal. What is the score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Mild-to-moderate sensory loss in one area (right arm) that is not severe scores a 1 on NIHSS Item 8.
Question 5: Which body regions should be tested during NIHSS sensory assessment?
- Face, arm, trunk, and leg (Correct answer)
- Arm and leg only
- Face and dominant hand only
- All four extremities and trunk, but not face
Correct answer: Face, arm, trunk, and leg
NIHSS sensory testing includes the face, arm, trunk, and leg to map the distribution of sensory loss.
Question 6: A patient with right-sided stroke has no sensation whatsoever on the left face, arm, and leg. What is the NIHSS sensory score?
- 0
- 1
- 2 (Correct answer)
- Cannot score without MRI confirmation
Correct answer: 2
Complete absence of sensation on the affected side across multiple body regions scores 2 (severe to total sensory loss).
Question 7: A patient has a sensory loss that the examiner suspects is pre-existing diabetic neuropathy, not stroke-related. How should this affect the NIHSS score?
- Score based on all sensory findings regardless of cause
- Only score sensory loss attributable to the stroke (Correct answer)
- Skip the item if any pre-existing neuropathy exists
- Default to score 2 to be conservative
Correct answer: Only score sensory loss attributable to the stroke
NIHSS Item 8 instructs examiners to score only the sensory loss attributed to the stroke, not pre-existing conditions.
NIHSS Sensory Testing 2
A patient with a brainstem stroke has decreased sensation on both sides of the body.
How should NIHSS Item 8 be scored?