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NIHSS Group A Version 5
Patient 1 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0. This indicates full wakefulness without any sedation or confusion. Item 1b โ LOC Questions: The patient answers both questions correctly, scoring 0. This shows intact orientation to month and age. Item 1c โ LOC Commands: The patient performs both tasks (opening/closing eyes and gripping/releasing hand) correctly, scoring 0. This demonstrates intact comprehension and motor response to verbal commands. Item 2 โ Best Gaze: The patient has normal conjugate eye movement, scoring 0. There is no forced deviation or partial gaze palsy. Item 3 โ Visual: The patient has no visual loss, scoring 0. Visual fields are intact to confrontation testing. Item 4 โ Facial Palsy: The patient shows minor paralysis with a flattened nasolabial fold and asymmetry when smiling, scoring 1. This indicates mild lower facial weakness, suggesting cortical involvement.
Item 5a โ Motor Arm Left: The left arm shows no effort against gravity and falls, scoring 3. This represents significant weakness, indicating right hemispheric motor strip involvement. Item 5b โ Motor Arm Right: The right arm holds 90 degrees for the full 10 seconds without drift, scoring 0. This side is normal. Item 6a โ Motor Leg Left: The left leg drifts and falls by the end of the 5 - second period but does not hit the bed, scoring 1. This shows mild-to- moderate weakness. Item 6b โ Motor Leg Right: The right leg holds 30 degrees for the full 5 seconds, scoring 0. This is normal. Item 7 โ Limb Ataxia: No ataxia is present, scoring 0. The finger-to-nose and heel-to-shin tests are normal. Item 8 โ Sensory: Sensation is normal to pinprick and touch, scoring 0. Item 9 โ Best Language: Language is normal with fluent speech and intact comprehension, scoring 0. Item 10 โ Dysarthria: Speech is clear without slurring, scoring 0. Item 11 โ Extinction/Inattention: There is no neglect or extinction to double simultaneous stimulation, scoring 0. Total Score for Patient 1 is 4. This patient has a mild right hemisphere stroke with left arm weakness being the dominant finding. Patient 2 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0. The patient appears awake and engaged.
Item 9 โ Best Language: There is severe aphasia, scoring 2. The patient has significant difficulty with naming, repetition, or comprehension, indicating dominant hemisphere involvement. Item 10 โ Dysarthria: Mild dysarthria is present, scoring 1. Speech is slightly slurred but intelligible. Item 11 โ Extinction/Inattention: No neglect or extinction is present, scoring 0. Total Score for Patient 2 is 5. This patient has a dominant hemisphere stroke with aphasia as the most significant feature, along with mild facial weakness and sensory loss. Patient 3 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0. Item 1b โ LOC Questions: Both orientation questions are answered correctly, scoring 0. Item 1c โ LOC Commands: Both commands are performed correctly, scoring 0. Item 2 โ Best Gaze: Partial gaze palsy is present, scoring 1. The patient has difficulty with full conjugate gaze to one side, indicating involvement of the brainstem or frontal eye fields. Item 3 โ Visual: Partial hemianopia is present, scoring 1. The patient has a visual field cut on one side.
Item 4 โ Facial Palsy: Minor paralysis is noted, scoring 1. There is asymmetry with smiling. Item 5a โ Motor Arm Left: The left arm drifts and falls before 10 seconds but does not hit the bed, scoring 1. This indicates mild-to- moderate weakness. Item 5b โ Motor Arm Right: The right arm holds 90 degrees for the full 10 seconds without drift, scoring 0. Item 6a โ Motor Leg Left: The left leg holds 30 degrees for the full 5 seconds without drift, scoring 0. Item 6b โ Motor Leg Right: The right leg holds 30 degrees for the full 5 seconds without drift, scoring 0. Item 7 โ Limb Ataxia: No ataxia is present, scoring 0. Item 8 โ Sensory: Sensation is normal, scoring 0. Item 9 โ Best Language: Language is normal, scoring 0. Item 10 โ Dysarthria: Mild dysarthria is present, scoring 1. Speech has some slurring. Item 11 โ Extinction/Inattention: No inattention is present, scoring 0. Total Score for Patient 3 is 4. This patient has a multifocal stroke pattern involving gaze, vision, facial function, and mild left arm weakness with dysarthria. Patient 4 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0.
Total Score for Patient 4 is 1. This is a very mild stroke with only isolated right leg drift, suggesting a small lacunar infarct. This is the mildest stroke in this group. Patient 5 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0. Item 1b โ LOC Questions: The patient answers one question correctly, scoring 1. Only one orientation item is answered accurately, suggesting mild confusion or subtle language difficulty. Item 1c โ LOC Commands: Both commands are performed correctly, scoring 0. Item 2 โ Best Gaze: Gaze is normal, scoring 0. Item 3 โ Visual: No visual loss is present, scoring 0. Item 4 โ Facial Palsy: Minor paralysis is present, scoring 1. The patient has facial asymmetry. Item 5a โ Motor Arm Left: The left arm holds 90 degrees without drift for the full 10 seconds, scoring 0. This side is unaffected. Item 5b โ Motor Arm Right: The right arm shows no effort against gravity and falls, scoring 3. This represents severe weakness indicating significant left hemispheric motor cortex involvement. Item 6a โ Motor Leg Left: The left leg holds 30 degrees for the full 5 seconds without drift, scoring 0. This side is normal.
Item 6b โ Motor Leg Right: The right leg shows no effort against gravity and falls, scoring 3. This severe leg weakness mirrors the arm weakness, confirming extensive left hemisphere involvement. Item 7 โ Limb Ataxia: No ataxia is present, scoring 0. Item 8 โ Sensory: Sensation is normal, scoring 0. Item 9 โ Best Language: Language is normal, scoring 0. The patient can speak and understand without difficulty despite the severe motor weakness. Item 10 โ Dysarthria: Mild dysarthria is present, scoring 1. Speech has minor slurring due to facial weakness. Item 11 โ Extinction/Inattention: No neglect is present, scoring 0. Total Score for Patient 5 is 8. This patient has a severe left hemisphere stroke with dense right-sided hemiparesis, making this the most severe stroke in the group. Patient 6 (Items 1โ11) Item 1a โ Level of Consciousness: The patient is alert and keenly responsive, scoring 0. Item 1b โ LOC Questions: Both questions are answered correctly, scoring 0. Item 1c โ LOC Commands: Both commands are performed correctly, scoring 0. Item 2 โ Best Gaze: Gaze is normal, scoring 0. Item 3 โ Visual: No visual loss is present, scoring 0.
Patient 4 scores 1 with only isolated right leg drift. Patient 5 scores 8 with dense right-sided hemiparesis, making this the most severe stroke in the group. Patient 6 scores 0 with no deficits.
