Part 1 (a, b, c) - correct answer *LEVEL OF CONSCIOUSNESS*
*1a: Arousal*
0 = alert
1 = drowsy; awakens w minor stimulation
2 = obtunded or needs
... [Show More] repeated stimulation
3 = reflexive responses only or unresponsive
*1b: Questions* = Name and current month, +1 for language barrier
0 = both questions
1 = one
2 = neither question
*1c: Commands* = Open and close eyes, grip and release non-paretic hands
0 = both
1 = one
2 = neither
Part 2-3 - correct answer *EYES*
*2: Gaze*
0 = Normal
1 = Gaze deviation that can be overcome (preference)
2 = Forced gaze deviation (palsy)
*Isolated palsy = 1
*3: Visual Fields* via confrontation or threat if comatose
1 = partial hemianopia
2 = complete hemianopia
3 = total blindness bilat (cortical blindness)
*If pt has unilat blindness, use good eye for fields
Part 4 - correct answer *FACE* - Ask patient to smile and raise eyebrows. If obtunded, use grimace to pain.
1 = mild asymmetry (nasolabial field flattened)
2 = lower facial droop
3 = complete paralysis of 1 or both sides of face including upper face
Part 5-6 - correct answer *MOTOR STRENGTH*
*5a and b* = *Arm strength* via raise each arm to 45 degrees if supine, 90 degrees if sitting.
0 = no drift
1 = mild drift w/o hitting bed
2 = limb drifts down to bed before 10 secs (arm) or 5 seconds (leg)
3 = no effort against gravity
4 = no movement at all
*UN - amputation or joint fusion, document why
*6a and 6b = Leg strength* via raise each leg to 30 degrees (supine).
0 = no drift
1 = mild w/o hitting bed
2 = limb drifts down to bed before 10 sec (arm) or 5 sec (leg)
3 = no effort against gravity
4 = no movement at all
*UN - amputation or joint fusion, document why
Most strokes are _____. Weakness is greater _____ than ______. - correct answer *Cortical*, weaker proximally than distally
Part 7 - correct answer *LIMB ATAXIA*
Test finger to nose and heel to shin. Only scored if positive.
0 = absent or patient is comatose or paralyzed
1 = ataxia in one limb
2 = present in both limbs
*UN if amputation or joint effusion, explain
Part 8 - correct answer *SENSORY*
Test pinprick w safety pin in all four limbs
0 = normal, no sensory loss
1 = mild-mod sensory loss. Patient usually aware of being touched on hemisensory loss side.
2 = severe or total sensory loss; not aware
*Patient who do not have reflexive responses to pain are given a 2
Part 9 - correct answer *LANGUAGE*
Aphasia: Have patient describe picture and name objects. If can't see, can ask questions and use large objects in room
0 = no aphasia
1 = mild-mod, examiner can understand most of what patient is saying
2 = severe aphasia, examiner can't understand
3 = mute or comatose.
*Intubated patient should be asked to write if possible
Part 10 - correct answer *DYSARTHRIA*
Slurred, garbled, or incoherent speech. Have patient read sentences and words. If they cannot read can ask them to repeat "Methodist episcopal" although if aphasic, repetition is difficult.
0 = normal
1 = mild (mostly understood)
2 = severe or mute
UN = intubated
Part 11 - correct answer *EXTINCTION*
Extinction/Inattention. Tested in vision and sensory.
0 = no extinction. Only scored if present.
1 = extinction in any sensory modality (visual, tactile, auditory, personal inattention)
2 = more than one modality, profound neglect
What two components are "only scored if present", if not, they get 0 - correct answer Limb ataxia
Extinction
NIH means to distinguish between - correct answer Large and small strokes
Larger strokes are usually greater than ____ on the NIHSS - correct answer 10
NIHSS is heavily weight towards - correct answer Aphasic left hemisphere MCA strokes
*Brainstem strokes could have lower score despite being just as serious if not more serious
Total score is from 0 to - correct answer 42 [Show Less]