NIHSS

[Bagboy]

I'm learning the NIHSS, and having some problems with terminology regarding "Best Gaze." I hope some of you brainiacs can unravel this for me in simple terms.

"1 = partial gaze palsy - abnormality in one or both eyes, but forced deviation is not present. If the patient has a conjugate deviation of both eyes that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI), score a 1."

I *think* the "partial gaze palsy" means that one of the eyes is not able to completely move along the horizontal plane because either the medial or lateral rectus muscles aren't being properly innervated by CN III or VI to pull the eye either left or right.

What is "Forced deviation"?

I also don't understand the part that says, "...that can be overcome by voluntary or reflexive activity."

Also, how am I supposed to know, "If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI)"?

I'm looking on Google and YouTube but just can't seem to wrap my mind around these terms!!!!

[MelEpiRN]

You'll know forced gaze deviation when you see it. Eyes are deviated to either the right or left and won't move. You can't get the patient to look the other direction at all, and when you turn their head the gaze still doesn't move. (And it's not 100%, but usually the gaze is directed away from the side the stroke is occurring on, so L sided stroke = R sided gaze. In seizure, the gaze is often to the side of the brain that's seizing).

Scoring a 1 would be an inability to move one or both eyes fully in both directions. So, often we see patients who can move their eyes to the center, and then goes back to one side. If you turn their head, they can overcome the deviation.