NIHSS Visual Field Testing 3

Question 1

The NIHSS visual field item uses confrontation testing. How many fingers does the examiner typically use when testing each quadrant?

Accepted Answer

Two fingers simultaneously in opposing quadrants

Answer

The standard technique is simultaneous finger counting in upper and lower quadrants to detect field defects efficiently.

Question 2

A patient correctly detects finger movement in the left visual field but misses it every time it is presented simultaneously with the right. Without simultaneous presentation, the left field is intact. What does this finding suggest?

Accepted Answer

Left visual extinction/neglect

Answer

Extinction only on simultaneous bilateral stimulation indicates visual neglect (extinction), not a true field cut.

Question 3

On NIHSS item 3, a patient has a right superior quadrantanopia ('pie in the sky' defect). What score is assigned?

Accepted Answer

1

Answer

A quadrantanopia is a partial field defect and scores 1 on NIHSS item 3.

Question 4

Why is it important to test each eye's visual fields from directly in front during NIHSS assessment rather than from the side?

Accepted Answer

To ensure fixation is maintained and peripheral fields are tested symmetrically

Answer

Testing from in front while the patient fixates on the examiner's nose ensures symmetric evaluation of all four quadrants without head-turn compensation.

Question 5

A patient scores 1 on NIHSS item 3 due to left inferior quadrantanopia after an acute stroke. Which cortical area is most likely affected?

Accepted Answer

Right parietal-occipital junction (superior optic radiation)

Answer

Inferior quadrantanopia ('pie in the floor') results from damage to the superior optic radiations in the parietal-occipital region.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Visual Field Testing 3