The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam.
But… how do you test gaze if your patient is aphasic or unable to follow commands?