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NIHSS Group A Version 5
PATIENT 1
Total Score: 4 1a. Level of Consciousness (Score: 0) - The patient is alert and responsive. The examiner easily arouses the patient, who is not drowsy or confused. 1b. LOC Questions (Score: 0) - The patient answers both questions correctly, identifying the current month and their age without difficulty. 1c. LOC Commands (Score: 0) - The patient performs both tasks as instructed: opening and closing their eyes and gripping and releasing on command.
2. Best Gaze (Score: 0) - Normal eye movement with no difficulty tracking objects horizontally. 3. Visual (Score: 0) - The patient has no visual loss. In testing, the patient can see and respond to visual stimuli in all four quadrants. 4. Facial Palsy (Score: 1) - Minor paralysis is present. The patient has a flattened nasolabial fold and some asymmetry, especially when smiling. 5a. Motor Arm Left (Score: 3) - No effort against gravity. The left arm falls to the bed after 10 seconds. The patient cannot lift the arm against gravity.
5b. Motor Arm Right (Score: 0) - No drift. The right arm holds 90 degrees for a full 10 seconds without falling. 6a. Motor Leg Left (Score: 1) - Drift. The left leg falls by the end of the 5 - second period but does not hit the bed. 6b. Motor Leg Right (Score: 0) - No drift. The right leg holds 30 degrees for a full 5 seconds without falling.
7. Limb Ataxia (Score: 0) - No ataxia. The finger-to-nose and heel-to- shin tests are performed smoothly with coordination. 8. Sensory (Score: 2) - Severe hemisensory loss. This is a confirmed substantial loss of sensation, not merely a subtle difference. 9. Best Language (Score: 0) - The patient's speech is fluent and comprehensible. There is no aphasia present. 10. Dysarthria (Score: 0) - Speech is clear. The patient's articulation is normal without slurring. 11. Extinction/Inattention (Score: 1) - Visual or tactile extinction. The patient shows inattention to a stimulus in one field when both sides are stimulated simultaneously. PATIENT 2 Total Score: 5 1a. Level of Consciousness (Score: 0) - The patient is alert and awake, responding appropriately to the examiner. 1b. LOC Questions (Score: 2) - Answers both incorrectly. The patient is not able to correctly identify the month or their age.
PATIENT 3
Total Score: 4 1a. Level of Consciousness (Score: 0) - The patient is alert and responsive. 1b. LOC Questions (Score: 0) - Answers both questions correctly. 1c. LOC Commands (Score: 0) - Performs both tasks correctly as instructed.
2. Best Gaze (Score: 1) - Partial gaze palsy. There is a limitation in the horizontal eye movements of one eye. 3. Visual (Score: 1) - Partial hemianopia. The patient is unable to see in a portion of their visual field. 4. Facial Palsy (Score: 1) - Minor paralysis. Asymmetry is present with flattening of the nasolabial fold. 5a. Motor Arm Left (Score: 1) - Drift. The arm drifts down before 10 seconds but does not hit the bed. 5b. Motor Arm Right (Score: 0) - No drift. Holds position without falling. 6a. Motor Leg Left (Score: 0) - No drift. Holds position without falling. 6b. Motor Leg Right (Score: 0) - No drift. Holds position without falling. 7. Limb Ataxia (Score: 0) - No ataxia. Coordination is intact. 8. Sensory (Score: 0) - Normal sensory function with intact sensation to pinprick.
9. Best Language (Score: 0) - Normal language function with no aphasia. 10. Dysarthria (Score: 1) - Mild-moderate dysarthria. The patient slurs some words but is understandable. 11. Extinction/Inattention (Score: 0) - No neglect or extinction is present. PATIENT 4 Total Score: 1 1a. Level of Consciousness (Score: 0) - The patient is alert and responsive. 1b. LOC Questions (Score: 0) - Answers both questions correctly. 1c. LOC Commands (Score: 0) - Performs both tasks correctly. 2. Best Gaze (Score: 0) - Normal eye movement with no gaze abnormality. 3. Visual (Score: 0) - Normal visual fields with no loss detected. 4. Facial Palsy (Score: 1) - Minor paralysis. Some asymmetry is noted in the lower face. 5a. Motor Arm Left (Score: 0) - No drift. Holds position without falling. 5b. Motor Arm Right (Score: 0) - No drift. Holds position without falling. 6a. Motor Leg Left (Score: 0) - No drift. Holds position without falling. 6b. Motor Leg Right (Score: 1) - Drift. The leg falls by the end of the 5- second period but does not hit the bed.
5b. Motor Arm Right (Score: 3) - No effort against gravity. Right arm falls after 10 seconds with no attempt to hold position. 6a. Motor Leg Left (Score: 1) - Drift. The leg drifts down but does not hit the bed. 6b. Motor Leg Right (Score: 3) - No effort against gravity. The right leg falls immediately with no attempt to hold position.
7. Limb Ataxia (Score: 1) - Ataxia in one limb. The patient is uncoordinated in the finger-to-nose test on one side. 8. Sensory (Score: 1) - Mild-moderate sensory loss. The patient has a subtle decreased sensation to pinprick. 9. Best Language (Score: 0) - Normal language function with no aphasia. 10. Dysarthria (Score: 1) - Mild-moderate dysarthria. The patient slurs at least some words. 11. Extinction/Inattention (Score: 1) - Visual or tactile extinction. Shows inattention when double simultaneous stimulation is performed. PATIENT 6 Total Score: 0 1a. Level of Consciousness (Score: 0) - The patient is alert and responsive. 1b. LOC Questions (Score: 0) - Answers both questions correctly. 1c. LOC Commands (Score: 0) - Performs both tasks correctly.
2. Best Gaze (Score: 0) - Normal eye movement with no gaze palsy. 3. Visual (Score: 0) - Normal visual fields with no loss. 4. Facial Palsy (Score: 0) - Normal symmetry with no facial weakness. 5a. Motor Arm Left (Score: 0) - No drift. Holds position without falling. 5b. Motor Arm Right (Score: 0) - No drift. Holds position without falling. 6a. Motor Leg Left (Score: 0) - No drift. Holds position without falling. 6b. Motor Leg Right (Score: 1) - Drift. The leg falls by the end of the 5- second period but does not hit the bed. 7. Limb Ataxia (Score: 0) - No ataxia is present. 8. Sensory (Score: 1) - Mild-moderate sensory loss. A slight decrease in sensation is noted to pinprick. 9. Best Language (Score: 0) - Normal language function with no aphasia. 10. Dysarthria (Score: 0) - Clear speech with normal articulation. 11. Extinction/Inattention (Score: 0) - No neglect or extinction is present. SUMMARY OF ALL PATIENT SCORES Patient 1: 1a=0, 1b=0, 1c=0, 2=0, 3=0, 4=1, 5a=3, 5b=0, 6a=1, 6b=0, 7=0, 8=2, 9=0, 10=0, 11=1. Total Score = 4 Patient 2: 1a=0, 1b=2, 1c=0, 2=0, 3=0, 4=1, 5a=0, 5b=0, 6a=0, 6b=0, 7=0, 8=1, 9=2, 10=1, 11=0. Total Score = 5
