NIHSS GROUP C PATIENTS 1-6 ANSWER KEY 2026/2027 |
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Patient C1: Mild Brainstem Stroke - Dysarthria, Right-Sided Ataxia, No Motor
Weakness
Patient C1 - Item 1a: Level of Consciousness (LOC):
Patient is awake, alert, and responsive to questions and commands without any
stimulation. Follows all instructions appropriately.
A. 1 - Not alert but arousable by minor stimulation
B. 2 - Not alert, requires repeated stimulation to attend
C. 0 - Alert, keenly responsive [CORRECT]
D. 3 - Unresponsive or responds only with reflex motor effects
Correct Answer: C
Rationale: Patient is awake and responsive without stimulation, scoring 0. Brainstem
strokes with mild severity typically spare reticular activating system. Score 1 requires
drowsy/arousable, score 2 requires obtunded/repeated stimulation, score 3 requires
coma.
Patient C1 - Item 1b: LOC Questions (Month and Age):
Patient is alert and oriented. When asked "What month is it?" patient correctly responds
"April." When asked "How old are you?" patient correctly responds "62."
A. 2 - Answers neither correctly
B. 1 - Answers one correctly
C. 0 - Answers both correctly [CORRECT]
D. NT - Not testable (intubated/aphasic)
Correct Answer: C
Rationale: Patient answered both month and age correctly, scoring 0. Brainstem stroke
does not affect language or consciousness in mild cases. Score 1 if only one correct,
score 2 if neither correct, NT only for intubation or aphasia.
Patient C1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient follows commands. When asked to open and close eyes, patient performs
correctly. When asked to grip and release non-paretic hand (left hand), patient performs
correctly.
A. 2 - Performs neither
B. 1 - Performs one correctly
C. 0 - Performs both correctly [CORRECT]
D. NT - Not testable (amputation/joint fusion)
,Correct Answer: C
Rationale: Patient performed both commands correctly, scoring 0. Brainstem strokes
with mild severity do not impair command following. Score 1 if only one correct, score 2
if neither, NT only for amputation/joint fusion.
Patient C1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze palsy, no nystagmus (nystagmus not scored but noted clinically).
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: Patient has full conjugate eye movements without gaze deviation or palsy,
scoring 0. Mild brainstem stroke may spare gaze centers (PPRF in pons, MLF, CN VI
nucleus). Score 1 for partial gaze palsy, score 2 for forced deviation.
Patient C1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient sees fingers in all four quadrants bilaterally. No visual
field cut detected. Visual threat response present.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 0 - No visual loss [CORRECT]
Correct Answer: D
Rationale: Patient has intact visual fields, scoring 0. Brainstem strokes may cause
visual field cuts if optic tracts affected, but mild strokes spare vision. Score 1 for
quadrantanopia, score 2 for complete hemianopia, score 3 for bilateral blindness.
Patient C1 - Item 4: Facial Palsy:
Patient has symmetric facial movement. When asked to show teeth, both sides move
equally. Nasolabial folds symmetric. Eyebrow elevation and eye closure symmetric.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (lower face)
C. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile)
D. 0 - Normal symmetric movement [CORRECT]
Correct Answer: D
Rationale: Patient has normal symmetric facial movement, scoring 0. Mild brainstem
stroke spares CN VII nucleus or fascicles. Score 1 for minor, score 2 for partial, score 3
for complete.
, Patient C1 - Item 5: Motor Arm - Left (Non-ataxic):
Patient extends left arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left arm, scoring 0. No motor weakness in this
mild ataxic stroke. Score 1 for drift, score 2 for some effort but cannot maintain, score 3
for no effort, score 4 for no movement.
Patient C1 - Item 5: Motor Arm - Right (Ataxic but not weak):
Patient extends right arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift. Strength is normal despite ataxia (dysmetria on finger-to-nose, not
weakness).
A. 4 - No movement (flaccid)
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: Patient has normal strength in right arm (no drift), scoring 0. Ataxia
(dysmetria) is scored on item 7 (limb ataxia), not on motor arm (which tests
strength/drift). Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for
no effort, score 4 for no movement.
Patient C1 - Item 6: Motor Leg - Left (Non-ataxic):
Patient is supine. Left leg is raised 30 degrees. Leg maintains position for full 5 seconds
without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left leg, scoring 0. No motor weakness. Score
1 for drift, score 2 for some effort but cannot maintain, score 3 for leg falls, score 4 for
no movement.
Patient C1 - Item 6: Motor Leg - Right (Ataxic but not weak):
Patient is supine. Right leg is raised 30 degrees. Leg maintains position for full 5
seconds without drift. Strength normal despite ataxia on heel-to-shin.
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Patient C1: Mild Brainstem Stroke - Dysarthria, Right-Sided Ataxia, No Motor
Weakness
Patient C1 - Item 1a: Level of Consciousness (LOC):
Patient is awake, alert, and responsive to questions and commands without any
stimulation. Follows all instructions appropriately.
A. 1 - Not alert but arousable by minor stimulation
B. 2 - Not alert, requires repeated stimulation to attend
C. 0 - Alert, keenly responsive [CORRECT]
D. 3 - Unresponsive or responds only with reflex motor effects
Correct Answer: C
Rationale: Patient is awake and responsive without stimulation, scoring 0. Brainstem
strokes with mild severity typically spare reticular activating system. Score 1 requires
drowsy/arousable, score 2 requires obtunded/repeated stimulation, score 3 requires
coma.
Patient C1 - Item 1b: LOC Questions (Month and Age):
Patient is alert and oriented. When asked "What month is it?" patient correctly responds
"April." When asked "How old are you?" patient correctly responds "62."
A. 2 - Answers neither correctly
B. 1 - Answers one correctly
C. 0 - Answers both correctly [CORRECT]
D. NT - Not testable (intubated/aphasic)
Correct Answer: C
Rationale: Patient answered both month and age correctly, scoring 0. Brainstem stroke
does not affect language or consciousness in mild cases. Score 1 if only one correct,
score 2 if neither correct, NT only for intubation or aphasia.
Patient C1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient follows commands. When asked to open and close eyes, patient performs
correctly. When asked to grip and release non-paretic hand (left hand), patient performs
correctly.
A. 2 - Performs neither
B. 1 - Performs one correctly
C. 0 - Performs both correctly [CORRECT]
D. NT - Not testable (amputation/joint fusion)
,Correct Answer: C
Rationale: Patient performed both commands correctly, scoring 0. Brainstem strokes
with mild severity do not impair command following. Score 1 if only one correct, score 2
if neither, NT only for amputation/joint fusion.
Patient C1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze palsy, no nystagmus (nystagmus not scored but noted clinically).
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: Patient has full conjugate eye movements without gaze deviation or palsy,
scoring 0. Mild brainstem stroke may spare gaze centers (PPRF in pons, MLF, CN VI
nucleus). Score 1 for partial gaze palsy, score 2 for forced deviation.
Patient C1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient sees fingers in all four quadrants bilaterally. No visual
field cut detected. Visual threat response present.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia
D. 0 - No visual loss [CORRECT]
Correct Answer: D
Rationale: Patient has intact visual fields, scoring 0. Brainstem strokes may cause
visual field cuts if optic tracts affected, but mild strokes spare vision. Score 1 for
quadrantanopia, score 2 for complete hemianopia, score 3 for bilateral blindness.
Patient C1 - Item 4: Facial Palsy:
Patient has symmetric facial movement. When asked to show teeth, both sides move
equally. Nasolabial folds symmetric. Eyebrow elevation and eye closure symmetric.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (lower face)
C. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile)
D. 0 - Normal symmetric movement [CORRECT]
Correct Answer: D
Rationale: Patient has normal symmetric facial movement, scoring 0. Mild brainstem
stroke spares CN VII nucleus or fascicles. Score 1 for minor, score 2 for partial, score 3
for complete.
, Patient C1 - Item 5: Motor Arm - Left (Non-ataxic):
Patient extends left arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left arm, scoring 0. No motor weakness in this
mild ataxic stroke. Score 1 for drift, score 2 for some effort but cannot maintain, score 3
for no effort, score 4 for no movement.
Patient C1 - Item 5: Motor Arm - Right (Ataxic but not weak):
Patient extends right arm 90 degrees (sitting position). Arm maintains position for full 10
seconds without drift. Strength is normal despite ataxia (dysmetria on finger-to-nose, not
weakness).
A. 4 - No movement (flaccid)
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: Patient has normal strength in right arm (no drift), scoring 0. Ataxia
(dysmetria) is scored on item 7 (limb ataxia), not on motor arm (which tests
strength/drift). Score 1 for drift, score 2 for some effort but cannot maintain, score 3 for
no effort, score 4 for no movement.
Patient C1 - Item 6: Motor Leg - Left (Non-ataxic):
Patient is supine. Left leg is raised 30 degrees. Leg maintains position for full 5 seconds
without drift.
A. 4 - No movement (flaccid)
B. 2 - Some effort against gravity
C. 0 - No drift [CORRECT]
D. 1 - Drift
Correct Answer: C
Rationale: Patient has normal strength in left leg, scoring 0. No motor weakness. Score
1 for drift, score 2 for some effort but cannot maintain, score 3 for leg falls, score 4 for
no movement.
Patient C1 - Item 6: Motor Leg - Right (Ataxic but not weak):
Patient is supine. Right leg is raised 30 degrees. Leg maintains position for full 5
seconds without drift. Strength normal despite ataxia on heel-to-shin.
