NIH STROKE SCALE GROUP A PATIENT 1-6 COMPLETE
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Patient 1: Right Hemisphere Stroke - Left Hemiplegia, Left Hemianopia, Left
Neglect, Mild Dysarthria
Patient 1 - 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: The patient is awake and interacts normally without the need for stimulation.
According to NINDS guidelines, an alert and keenly responsive patient scores 0. Scores
1-3 require increasing levels of stimulation to arouse the patient.
Patient 1 - 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 "68."
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: The patient correctly answered both the month and age questions. NINDS
scoring dictates 0 for two correct answers. Score 1 is for one correct answer, and score
2 is for neither correct or inability to understand/respond due to aphasia/coma.
Patient 1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient is able to follow commands. When asked to open and close eyes, patient
performs correctly. When asked to grip and release non-paretic hand (right 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: The patient successfully performed both the eye and grip/release commands.
NINDS scoring rules assign 0 for two correct tasks. The grip must be tested on the
non-paretic hand if possible (which was done here).
Patient 1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze preference or partial gaze palsy noted.
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: The patient exhibits full range of horizontal eye movement voluntarily. Per
NINDS criteria, normal gaze scores 0. Score 1 indicates partial gaze palsy, and score 2
indicates forced deviation or total paresis not overcome by oculocephalic maneuver.
Patient 1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient is unable to see fingers or detect visual threat in the left
visual field (both upper and lower quadrants). Right visual field is intact.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia [CORRECT]
D. 0 - No visual loss
Correct Answer: C
Rationale: The patient has complete loss of vision in the left half of the visual field (left
hemianopia). NINDS defines score 2 as complete hemianopia. Score 1 is for partial
hemianopia/quadrantanopia, and score 3 is for bilateral blindness.
Patient 1 - Item 4: Facial Palsy:
Patient has asymmetry of the lower face. When asked to show teeth and smile, the left
side of the mouth does not elevate. The left nasolabial fold is flattened. Upper face
movements (raising eyebrows, squeezing eyes shut) are symmetric and normal.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
C. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile)
D. 0 - Normal symmetric movement
Correct Answer: B
Rationale: The patient has significant lower face paralysis with flattened nasolabial fold
but intact upper face function (forehead/eye movement). NINDS scoring distinguishes
score 2 (partial/lower face paralysis) from score 1 (minor asymmetry) and score 3
(complete upper and lower paralysis).
, Patient 1 - Item 5: Motor Arm - Left:
Patient extends left arm 90 degrees (sitting position). The arm immediately falls to the
side without any effort against gravity. No active movement is noted.
A. 2 - Some effort against gravity
B. 1 - Drift (arm drifts down but does not hit bed)
C. 4 - No movement (flaccid) [CORRECT]
D. 3 - No effort against gravity (arm falls, some contraction)
Correct Answer: C
Rationale: The arm falls immediately with no effort against gravity and no visible
contraction. NINDS defines score 4 as no movement (flaccid). Score 3 allows for some
effort/fall but with visible contraction, whereas 4 is complete absence of motor function.
Patient 1 - Item 5: Motor Arm - Right:
Patient extends right arm 90 degrees (sitting position). The arm maintains position for
the full 10 seconds without drift.
A. 3 - No effort against gravity
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: The right arm remains elevated for the full 10 seconds. NINDS scoring
criteria define score 0 as no drift (arm holds position for 10 seconds).
Patient 1 - Item 6: Motor Leg - Left:
Patient is supine. The left leg is raised 30 degrees. The leg immediately falls to the bed
without any effort against gravity.
A. 2 - Some effort against gravity
B. 1 - Drift (leg drifts down but does not hit bed)
C. 4 - No movement (flaccid) [CORRECT]
D. 3 - No effort against gravity (leg falls)
Correct Answer: C
Rationale: The left leg falls immediately with no effort against gravity. Per NINDS
criteria, if the leg falls to the bed immediately without the patient being able to hold it up
or move it against gravity, the score is 4 (no movement).
Patient 1 - Item 6: Motor Leg - Right:
Patient is supine. The right leg is raised 30 degrees. The leg maintains position for the
full 5 seconds without drift.
A. 3 - No effort against gravity
B. 2 - Some effort against gravity
C. 1 - Drift
2026/2027 | 100% Verified Answers | NIHSS Certification |
Pass Guaranteed - A+ Graded
Patient 1: Right Hemisphere Stroke - Left Hemiplegia, Left Hemianopia, Left
Neglect, Mild Dysarthria
Patient 1 - 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: The patient is awake and interacts normally without the need for stimulation.
According to NINDS guidelines, an alert and keenly responsive patient scores 0. Scores
1-3 require increasing levels of stimulation to arouse the patient.
Patient 1 - 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 "68."
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: The patient correctly answered both the month and age questions. NINDS
scoring dictates 0 for two correct answers. Score 1 is for one correct answer, and score
2 is for neither correct or inability to understand/respond due to aphasia/coma.
Patient 1 - Item 1c: LOC Commands (Open/Close Eyes, Grip/Release):
Patient is able to follow commands. When asked to open and close eyes, patient
performs correctly. When asked to grip and release non-paretic hand (right 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: The patient successfully performed both the eye and grip/release commands.
NINDS scoring rules assign 0 for two correct tasks. The grip must be tested on the
non-paretic hand if possible (which was done here).
Patient 1 - Item 2: Best Gaze (Horizontal Eye Movement):
Patient has conjugate horizontal eye movement. Eyes move fully to left and right without
deviation. No gaze preference or partial gaze palsy noted.
A. 2 - Forced deviation
B. 1 - Partial gaze palsy
C. 0 - Normal [CORRECT]
D. NT - Not testable
Correct Answer: C
Rationale: The patient exhibits full range of horizontal eye movement voluntarily. Per
NINDS criteria, normal gaze scores 0. Score 1 indicates partial gaze palsy, and score 2
indicates forced deviation or total paresis not overcome by oculocephalic maneuver.
Patient 1 - Item 3: Visual Fields (Confrontation Testing):
On confrontation testing, patient is unable to see fingers or detect visual threat in the left
visual field (both upper and lower quadrants). Right visual field is intact.
A. 3 - Bilateral hemianopia
B. 1 - Partial hemianopia (quadrantanopia)
C. 2 - Complete hemianopia [CORRECT]
D. 0 - No visual loss
Correct Answer: C
Rationale: The patient has complete loss of vision in the left half of the visual field (left
hemianopia). NINDS defines score 2 as complete hemianopia. Score 1 is for partial
hemianopia/quadrantanopia, and score 3 is for bilateral blindness.
Patient 1 - Item 4: Facial Palsy:
Patient has asymmetry of the lower face. When asked to show teeth and smile, the left
side of the mouth does not elevate. The left nasolabial fold is flattened. Upper face
movements (raising eyebrows, squeezing eyes shut) are symmetric and normal.
A. 3 - Complete paralysis (upper and lower face)
B. 2 - Partial paralysis (total or near-total paralysis of lower face) [CORRECT]
C. 1 - Minor paralysis (flattened nasolabial fold, asymmetric smile)
D. 0 - Normal symmetric movement
Correct Answer: B
Rationale: The patient has significant lower face paralysis with flattened nasolabial fold
but intact upper face function (forehead/eye movement). NINDS scoring distinguishes
score 2 (partial/lower face paralysis) from score 1 (minor asymmetry) and score 3
(complete upper and lower paralysis).
, Patient 1 - Item 5: Motor Arm - Left:
Patient extends left arm 90 degrees (sitting position). The arm immediately falls to the
side without any effort against gravity. No active movement is noted.
A. 2 - Some effort against gravity
B. 1 - Drift (arm drifts down but does not hit bed)
C. 4 - No movement (flaccid) [CORRECT]
D. 3 - No effort against gravity (arm falls, some contraction)
Correct Answer: C
Rationale: The arm falls immediately with no effort against gravity and no visible
contraction. NINDS defines score 4 as no movement (flaccid). Score 3 allows for some
effort/fall but with visible contraction, whereas 4 is complete absence of motor function.
Patient 1 - Item 5: Motor Arm - Right:
Patient extends right arm 90 degrees (sitting position). The arm maintains position for
the full 10 seconds without drift.
A. 3 - No effort against gravity
B. 1 - Drift
C. 2 - Some effort against gravity
D. 0 - No drift [CORRECT]
Correct Answer: D
Rationale: The right arm remains elevated for the full 10 seconds. NINDS scoring
criteria define score 0 as no drift (arm holds position for 10 seconds).
Patient 1 - Item 6: Motor Leg - Left:
Patient is supine. The left leg is raised 30 degrees. The leg immediately falls to the bed
without any effort against gravity.
A. 2 - Some effort against gravity
B. 1 - Drift (leg drifts down but does not hit bed)
C. 4 - No movement (flaccid) [CORRECT]
D. 3 - No effort against gravity (leg falls)
Correct Answer: C
Rationale: The left leg falls immediately with no effort against gravity. Per NINDS
criteria, if the leg falls to the bed immediately without the patient being able to hold it up
or move it against gravity, the score is 4 (no movement).
Patient 1 - Item 6: Motor Leg - Right:
Patient is supine. The right leg is raised 30 degrees. The leg maintains position for the
full 5 seconds without drift.
A. 3 - No effort against gravity
B. 2 - Some effort against gravity
C. 1 - Drift
