NIHSS Sensory Testing 4 — Questions and Answers
Question 1: Which NIHSS score correctly describes 'patient is aware of being touched but cannot identify sharpness versus dullness on the affected side'?
- 0
- 1 (Correct answer)
- 2
- This is scored under a different NIHSS item
Correct answer: 1
Inability to distinguish sharp from dull while still perceiving touch represents mild-to-moderate sensory loss, scored 1.
Question 2: A patient with a right hemisphere stroke shows no grimace, withdrawal, or any behavioral response to pinprick on the left side. The right side responds normally. What is the score?
- 0
- 1
- 2 (Correct answer)
- Score depends on whether the patient is conscious
Correct answer: 2
Complete absence of response to pinprick on the affected side with normal contralateral response indicates severe/total sensory loss, scored 2.
Question 3: Why does the NIHSS instruct examiners to give a confused or aphasic patient a score of 1 rather than 2, unless evidence of bilateral or widespread loss exists?
- Because confused patients feel less pain physiologically
- Because behavioral assessment may underestimate preserved sensation (Correct answer)
- Because score 2 is reserved only for comatose patients
- Because the NIHSS does not apply to aphasic patients
Correct answer: Because behavioral assessment may underestimate preserved sensation
Confused or aphasic patients may not demonstrate reliable responses, so a score of 1 is used to avoid over-scoring unless loss is clearly severe and widespread.
Question 4: A patient reports no sensory symptoms but the examiner detects that pinprick feels less sharp on the right arm. How is this scored?
- 0 — patient must report symptoms for score >0
- 1 — examiner-detected asymmetry is scored regardless of patient report (Correct answer)
- 2 — any detected asymmetry is considered severe
- The finding is disregarded if the patient denies symptoms
Correct answer: 1 — examiner-detected asymmetry is scored regardless of patient report
NIHSS Item 8 is based on examination findings; detected asymmetry on testing scores 1 even if the patient denies subjective symptoms.
Question 5: How is sensory testing on the face performed during NIHSS assessment?
- Stroke the cheek with a cotton ball
- Apply pinprick to both cheeks and compare responses (Correct answer)
- Test temperature discrimination at the forehead
- Lightly tap the perioral area and observe blink reflex
Correct answer: Apply pinprick to both cheeks and compare responses
Facial sensory testing involves applying pinprick to both cheeks and comparing the patient's response on each side.
Question 6: A patient has complete right hemisensory loss from a thalamic stroke. After 24 hours, some sensation returns in the arm but the leg remains anesthetic. What is the updated sensory score?
- 0 — partial return means normal
- 1 — some recovery with residual partial loss in one region (Correct answer)
- 2 — any remaining anesthetic area maintains score 2
- Score cannot change within 24 hours of stroke
Correct answer: 1 — some recovery with residual partial loss in one region
Partial sensory recovery with residual loss in one region represents mild-to-moderate hemisensory loss, scored 1.
Question 7: Which of the following would correctly justify a score of 0 for NIHSS Item 8?
- Patient reports mild tingling on the affected side
- Patient identifies pinprick as equally sharp on both sides (Correct answer)
- Patient withdraws on the affected side but not the normal side
- Patient is unable to communicate verbally
Correct answer: Patient identifies pinprick as equally sharp on both sides
Equally sharp pinprick perceived bilaterally with no asymmetry indicates normal sensation and a score of 0.
NIHSS Sensory Testing 4
Which NIHSS score correctly describes 'patient is aware of being touched but cannot identify sharpness versus dullness on the affected side'?