NIHSS Sensory Testing 3 — Questions and Answers
Question 1: An aphasic patient cannot verbally report sensory changes. How should the NIHSS sensory item be administered?
- Score 0 because verbal report is required
- Observe grimace or withdrawal to pinprick as a response (Correct answer)
- Score 1 by default for all aphasic patients
- Skip the item and mark it as untestable
Correct answer: Observe grimace or withdrawal to pinprick as a response
In aphasic patients, the examiner observes behavioral responses such as grimacing or withdrawal rather than relying on verbal reports.
Question 2: What NIHSS sensory score is assigned to a patient who feels a dull versus sharp difference but says 'it feels less sharp, not absent' on the affected side?
- 0 — sensation is present
- 1 — mild-to-moderate loss with awareness of stimulus (Correct answer)
- 2 — any asymmetry means severe loss
- Depends on which body part is tested
Correct answer: 1 — mild-to-moderate loss with awareness of stimulus
Awareness of the stimulus with reduced sharpness indicates mild-to-moderate sensory loss, scoring a 1.
Question 3: A patient is drowsy but withdraws from pinprick on both sides. What NIHSS sensory score applies?
- 0 — bilateral withdrawal indicates normal sensation (Correct answer)
- 1 — drowsy patients automatically receive score 1
- 2 — withdrawal in drowsy patients means severe loss
- Score cannot be determined in drowsy patients
Correct answer: 0 — bilateral withdrawal indicates normal sensation
Symmetric bilateral withdrawal from pinprick in a drowsy patient indicates intact sensation bilaterally, scoring 0.
Question 4: In the NIHSS, which score indicates that a patient has NO sensory loss?
- 0 (Correct answer)
- 1
- 2
- NT
Correct answer: 0
A score of 0 on NIHSS Item 8 means normal sensation — no sensory loss is detected.
Question 5: A patient has a cortical stroke and reports that the left arm feels 'numb and tingling' but pain is still perceived. How is this scored?
- 0 — pain is perceived so sensation is intact
- 1 — partial sensory loss with preserved pain perception (Correct answer)
- 2 — any numbness indicates severe loss
- This symptom is not captured by NIHSS sensory testing
Correct answer: 1 — partial sensory loss with preserved pain perception
Perceived numbness with partially preserved pain sensation represents mild-to-moderate loss, scored as 1.
Question 6: When testing NIHSS sensory function, what comparison is being made?
- Proximal versus distal sensation on the same limb
- Affected side versus unaffected side (Correct answer)
- Upper extremity versus lower extremity on the same side
- Current versus prior examination baseline
Correct answer: Affected side versus unaffected side
NIHSS sensory testing compares sensation on the affected (stroke) side to the unaffected side to detect asymmetry.
Question 7: A patient with a left MCA stroke has decreased sensation in the right arm and leg but normal sensation in the right face. What is the NIHSS sensory score?
- 0 — face is spared so no sensory deficit
- 1 — partial hemisensory loss without facial involvement (Correct answer)
- 2 — any hemisensory pattern scores maximum
- Scores must be obtained from all regions before assigning
Correct answer: 1 — partial hemisensory loss without facial involvement
Decreased but not absent sensation in two body regions without complete loss scores a 1 on Item 8.
NIHSS Sensory Testing 3
An aphasic patient cannot verbally report sensory changes.
How should the NIHSS sensory item be administered?