Unlock The Secret To Perfect Scores: Nihss Stroke Scale Test A Answers Revealed!

Ever tried to score a stroke on the fly and felt like you were guessing the answer key?
And you’re not alone. In the ER, the NIHSS (National Institutes of Health Stroke Scale) is the go‑to tool, but the “right” answers can feel like a secret code.

What if you could walk into any shift, glance at the chart, and know exactly what each point means? Below is the full rundown of the NIHSS test—what it asks, how you score it, and the answers you’ll actually use in real life Nothing fancy..

What Is the NIHSS Stroke Scale

The NIHSS is a 15‑item neurologic exam designed to quantify stroke severity. Think of it as the “report card” you hand to the neurologist, the cath lab, and anyone else deciding on treatment.

Each item looks at a different brain function—level of consciousness, gaze, motor strength, language, and a few more. You give each a number, add them up, and you’ve got a score from 0 (no deficit) to 42 (severe stroke) Took long enough..

The 15 Items at a Glance

That list is the skeleton. The real meat is knowing what answer earns each point.

Why It Matters

A stroke is a race against time. The NIHSS tells you three things, fast:

1. How bad it is now – a score of 6 vs. 18 can mean the difference between IV tPA and a mechanical thrombectomy.
2. Where the brain is hurt – language deficits point to the dominant hemisphere; neglect points to the right parietal lobe.
3. How the patient will likely recover – higher scores correlate with larger infarcts and longer rehab.

Skip the scale or get the scoring wrong, and you could send a patient down the wrong treatment pathway. In practice, the “answers” are the specific observations that trigger each point.

How It Works (The Answers You Need)

Below each item, I’ll give you the exact wording you should be listening for, the movement you should see, and the point you assign. Think of it as the answer key you can actually use at the bedside Not complicated — just consistent..

1. Level of Consciousness (LOC)

Ask: “What is your name? Where are you?”

• 0 points – Fully alert, oriented to person, place, and time.
• 1 point – Not fully alert, but responds to some stimuli (e.g., “I’m sleepy”).
• 2 points – Responds only to painful stimuli (pinch).
• 3 points – Unresponsive to any stimulus.

Answer tip: If the patient can answer both questions correctly, you’re at 0. Anything less, move up the ladder.

2. LOC Questions

Ask: “What month is it?” and “What is your age?”

• 0 points – Both correct.
• 1 point – One correct, one wrong.
• 2 points – Both wrong or no response.

Answer tip: Even a “I think it’s June” when it’s August is a point.

3. LOC Commands

Ask: “Open and close your eyes” then “Grip my hand tightly.”

• 0 points – Both commands followed correctly.
• 1 point – One command followed, the other not.
• 2 points – Neither command followed.

4. Best Gaze

Observe: Follow a finger from left to right.

• 0 points – Full, conjugate gaze.
• 1 point – Partial gaze palsy (one side moves slower).
• 2 points – Forced deviation or total gaze palsy.

Answer tip: A subtle “drift” on the left side is still 1 point Easy to understand, harder to ignore..

5. Visual Fields

Confrontation test: Hold up fingers in each quadrant, ask the patient to name them It's one of those things that adds up..

• 0 points – No visual loss.
• 1 point – Partial hemianopia (one quadrant).
• 2 points – Complete hemianopia (half the visual field).
• 3 points – Bilateral hemianopia or cortical blindness.

6. Facial Palsy

Ask: “Show me your teeth, then smile.”

• 0 points – Normal symmetric movement.
• 1 point – Minor weakness of lower face.
• 2 points – Moderate weakness (asymmetry obvious).
• 3 points – Complete paralysis of one side.

7. Motor Arm

Test: Raise each arm to 90°, hold for 5 s.

• 0 points – No drift.
• 1 point – Drift before 5 s, but can hold.
• 2 points – Some effort against gravity but cannot hold 5 s.
• 3 points – No effort against gravity.
• 4 points – No movement at all.

Answer tip: Score each arm separately, then use the worst side for the total (max 4).

8. Motor Leg

Same as arm, but legs.

• 0–4 points follow the same pattern as the arm.

9. Limb Ataxia

Finger‑nose (upper) and heel‑shin (lower) tests.

• 0 points – No ataxia.
• 1 point – Dysmetria in one limb.
• 2 points – Dysmetria in two limbs.

10. Sensory

Light touch with cotton, pinprick.

• 0 points – Normal.
• 1 point – Decreased sensation in one limb.
• 2 points – Decreased in two limbs or one entire side.

11. Best Language

Ask: “Describe a picture,” name objects, repeat a sentence.

• 0 points – No aphasia.
• 1 point – Mild aphasia (some word-finding difficulty).
• 2 points – Moderate aphasia (speech halts, many errors).
• 3 points – Severe global aphasia (no meaningful speech).

12. Dysarthria

Listen to simple words (“apple”).

• 0 points – Normal articulation.
• 1 point – Mild slurring.
• 2 points – Severe slurring, unintelligible.

13. Extinction/Inattention (Neglect)

Double simultaneous stimulation (touch both wrists, ask “Which one did I touch?”) Worth knowing..

• 0 points – No neglect.
• 1 point – Visual or tactile extinction on one side.
• 2 points – Severe neglect (ignores one side completely).

Common Mistakes / What Most People Get Wrong

1. Counting “partial” as zero – Even a slight drift in the arm counts as 1 point.
2. Double‑scoring the same deficit – The NIHSS is additive, not cumulative. A facial droop that also causes speech difficulty only adds points for the facial item and the language item, not twice for the same weakness.
3. Skipping the “best” side – For motor items you always record the worst side, not the average.
4. Misinterpreting “extinction” – It’s not just “doesn’t see,” it’s the failure to notice a second stimulus when two are presented simultaneously.
5. Rushing the language test – If the patient can’t name objects but can repeat a sentence, you’re at 1 point, not 3.

Getting these wrong can swing the total score by 5–10 points, which in a borderline case could be the difference between “eligible for tPA” and “not eligible”.

Practical Tips / What Actually Works

• Carry a pocket cheat sheet – A laminated one‑page table with each item and the point thresholds.
• Standardize your script – Use the exact phrasing listed above; it eliminates ambiguity.
• Practice with a colleague – Role‑play the exam while the other watches the scoring. Muscle memory helps under pressure.
• Document the “worst side” rule – Write “Left arm – 3” instead of “Left 2, Right 1”.
• Re‑score after any change – If the patient improves after tPA, run the NIHSS again; you’ll see the real impact of treatment.
• Use the “time‑last‑known‑well” cue – A high score early on but rapid improvement may point to a transient ischemic attack (TIA) rather than a full stroke.

FAQ

Q: Can the NIHSS be used by nurses or EMTs?
A: Yes, after proper training. Many EMS systems have a “stroke screen” that mirrors the NIHSS, and nurses often perform it in the ED It's one of those things that adds up..

Q: What score triggers a mechanical thrombectomy?
A: Generally a score ≥6 with a large‑vessel occlusion on imaging. But the decision also depends on time window and patient factors.

Q: Is a perfect 0 score ever realistic?
A: In minor strokes, yes—especially if the deficit is purely sensory and resolves quickly. But most patients will have at least a 1‑point finding That's the part that actually makes a difference. No workaround needed..

Q: How often should I repeat the NIHSS?
A: Every 15 minutes during acute therapy, then at 24 h, and again before discharge Nothing fancy..

Q: Does the NIHSS cover posterior‑circulation strokes well?
A: Not entirely. It’s less sensitive to cerebellar or brainstem signs, so supplement with the Posterior Circulation Stroke Scale if you suspect those territories.

The short version? On the flip side, the NIHSS isn’t a mystery test; it’s a checklist with clear, observable answers. Memorize the key cues, keep a cheat sheet handy, and you’ll score strokes with confidence—every single time.

Now go ahead, pull out that scale, and let the numbers do the talking.