NIHSS Sensory Testing 5 — Questions and Answers
Question 1: During serial NIHSS assessments, a patient's sensory score improves from 2 to 0 over 6 hours. What does this suggest clinically?
- The initial assessment was inaccurate and should be corrected
- Sensory recovery, possibly from reperfusion or TIA resolution (Correct answer)
- Score 0 is impossible after a score of 2 without imaging confirmation
- The change is too rapid to be stroke-related
Correct answer: Sensory recovery, possibly from reperfusion or TIA resolution
Rapid improvement from severe sensory loss to normal may indicate reperfusion after thrombolysis or resolution of a TIA.
Question 2: A patient with sensory neglect on the left side consistently ignores stimuli on the left when both sides are stimulated simultaneously. Is this scored under NIHSS Item 8?
- Yes, sensory neglect is scored as Item 8 sensory loss
- No, extinction to double simultaneous stimulation is scored under Item 11 (Correct answer)
- Yes, and it automatically scores a 2
- No, neglect is not captured anywhere on the NIHSS
Correct answer: No, extinction to double simultaneous stimulation is scored under Item 11
Extinction to double simultaneous stimulation is captured under NIHSS Item 11 (Extinction and Inattention), not Item 8.
Question 3: A patient with a pontine hemorrhage has decreased facial sensation on the right and decreased body sensation on the left. Which NIHSS score best reflects this crossed sensory pattern?
- 0 — crossed findings indicate normal central processing
- 1 — crossed hemisensory loss is mild by definition
- 2 — bilateral involvement of different body parts indicates severe loss (Correct answer)
- The NIHSS cannot capture crossed sensory syndromes
Correct answer: 2 — bilateral involvement of different body parts indicates severe loss
Crossed sensory loss affecting both sides of the body (face and contralateral body) represents severe sensory dysfunction, scored 2.
Question 4: A patient reports that the affected arm feels 'dead' and has zero response to pinprick, but the face and leg have preserved sensation. What is the NIHSS sensory score?
- 0 — two regions are normal
- 1 — focal severe loss in one region is still partial (Correct answer)
- 2 — complete anesthesia in any region scores 2
- Score depends on the examiner's clinical judgment
Correct answer: 1 — focal severe loss in one region is still partial
Complete loss in one body part with preserved sensation in others represents partial hemisensory loss, which scores 1 rather than 2.
Question 5: What is the maximum possible score for NIHSS Item 8 (Sensory)?
- 1
- 2 (Correct answer)
- 3
- 4
Correct answer: 2
The maximum score for NIHSS Item 8 is 2, representing severe to total sensory loss on the affected side.
Question 6: A stroke patient is unable to detect pinprick on the right leg but has full sensation in the right arm and right face. How should sensory testing proceed?
- Score 2 — one region with no sensation means maximum score
- Score 1 — partial distribution of sensory loss (Correct answer)
- Score 0 — two of three regions are intact
- Repeat testing only in the affected leg before scoring
Correct answer: Score 1 — partial distribution of sensory loss
Isolated sensory loss in one body region with intact sensation elsewhere reflects partial (not total) hemisensory loss, scored 1.
Question 7: Which clinical scenario would correctly earn a score of 0 for NIHSS sensory testing in a patient who is unconscious?
- Patient withdraws symmetrically from pinprick on both sides (Correct answer)
- Patient does not respond to pinprick on either side
- Patient grimaces only on the unaffected side
- Unconscious patients always score 2 on sensory testing
Correct answer: Patient withdraws symmetrically from pinprick on both sides
Symmetric bilateral withdrawal from noxious stimulus in an unconscious patient indicates equal sensory processing and scores 0.
NIHSS Sensory Testing 5
During serial NIHSS assessments, a patient's sensory score improves from 2 to 0 over 6 hours.
What does this suggest clinically?