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NIH Stroke Scale Test 2 Questions with Answers

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NIH Stroke Scale Test 2 Questions with Answers Part 4 - 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 Pa...

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  • August 3, 2024
  • 3
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • NIH Stroke Scale
  • NIH Stroke Scale

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NIH Stroke Scale Test 2 Questions
with Answers
Part 4 - 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 - 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 ______. - Answer-*Cortical*,
weaker proximally than distally

Part 7 - 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 - 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

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