NIHSS Visual Field Testing 2 — Questions and Answers
Question 1: A patient has a right homonymous hemianopia detected during NIHSS visual field testing. What score does the examiner assign?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Partial visual field loss including hemianopia in one hemifield scores 1 on NIHSS item 3.
Question 2: During confrontation testing for NIHSS item 3, the patient correctly identifies finger movement only in the upper visual fields bilaterally. Lower fields are absent. Which score applies?
- 0 — normal
- 1 — partial visual loss (Correct answer)
- 2 — complete hemianopia
- 3 — bilateral blindness
Correct answer: 1 — partial visual loss
Loss restricted to quadrants (inferior quadrantanopia bilaterally) constitutes partial visual loss, scored as 1.
Question 3: When testing visual fields in an uncooperative patient on NIHSS, which method can be used as an alternative to confrontation finger counting?
- Visual evoked potentials
- Threatening gesture or visual threat (Correct answer)
- Fundoscopy
- Pupillary light reflex
Correct answer: Threatening gesture or visual threat
A visual threat (sudden hand movement toward the eye) can be used in patients who cannot cooperate with standard confrontation testing.
Question 4: A patient is blind in both eyes from pre-existing bilateral glaucoma. How should NIHSS item 3 be scored?
- Score 3 for bilateral blindness
- Score 0 because it is a pre-existing condition (Correct answer)
- Score 2 for complete hemianopia
- Score UN (untestable)
Correct answer: Score 0 because it is a pre-existing condition
Pre-existing conditions unrelated to the current stroke are not scored; the examiner records 0 and notes the prior baseline.
Question 5: A patient scores 3 on NIHSS item 3 (Visual). What does this indicate?
- Quadrantanopia only
- Unilateral hemianopia
- Complete bilateral hemianopia (bilateral blindness) (Correct answer)
- Monocular visual loss
Correct answer: Complete bilateral hemianopia (bilateral blindness)
A score of 3 indicates bilateral visual field loss resulting in blindness affecting both hemifields.
Question 6: Which visual field defect would most likely score 2 on NIHSS item 3?
- Right superior quadrantanopia only
- Left homonymous hemianopia (Correct answer)
- Left superior quadrantanopia only
- Bilateral peripheral constriction
Correct answer: Left homonymous hemianopia
Complete hemianopia (loss of an entire hemifield) scores 2 on NIHSS item 3.
Question 7: During NIHSS assessment, a patient with left middle cerebral artery stroke shows visual field neglect but no true field cut on careful testing. What is the NIHSS item 3 score?
- 0
- 1 (Correct answer)
- 2
- 3
Correct answer: 1
Visual neglect without a true field cut is scored as partial visual loss (1) under NIHSS item 3.
NIHSS Visual Field Testing 2
A patient has a right homonymous hemianopia detected during NIHSS visual field testing.
What score does the examiner assign?