NIHSS Visual Field Testing 5

Question 1

Which anatomical lesion is most likely to produce a bitemporal hemianopia that would score 2 on NIHSS item 3?

Accepted Answer

Optic chiasm compression or ischemia

Answer

Bitemporal hemianopia is a chiasmal lesion pattern; if it causes complete loss of both temporal fields, it scores 2.

Question 2

A patient with posterior circulation stroke cannot fixate because of oculomotor dysfunction. How should the examiner adapt NIHSS item 3 visual field testing?

Accepted Answer

Use a visual threat response to each hemifield independently

Answer

Visual threat (blink response to sudden hand movement in each hemifield) can be performed even when the patient cannot fixate voluntarily.

Question 3

An examiner presents two fingers simultaneously in the right and left upper quadrants. The patient reports seeing fingers only on the right. On isolated left field testing, the left upper field is intact. What is the correct NIHSS item 3 score and interpretation?

Accepted Answer

1 — partial loss due to left visual extinction

Answer

Extinction to double simultaneous stimulation with intact fields when tested alone is scored as partial visual loss (1) under NIHSS item 3.

Question 4

A patient with a large left hemisphere MCA stroke is aphasic and cannot follow commands. The examiner performs a visual threat in each hemifield. The patient blinks to threat on the left but not on the right. What NIHSS item 3 score is appropriate?

Accepted Answer

2

Answer

Absent blink-to-threat in the entire right hemifield indicates complete right hemianopia, scored as 2.

Question 5

The NIHSS item 3 scoring scale is 0–3. Which of the following correctly maps scores to findings?

Accepted Answer

0=normal, 1=quadrantanopia/partial loss, 2=complete hemianopia, 3=bilateral blindness

Answer

The correct mapping is 0=no loss, 1=partial loss (including quadrantanopia or neglect), 2=complete hemianopia, 3=bilateral blindness.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Visual Field Testing 5