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==Physical Examination==
==Physical Examination==
*Findings in physical examination of patients with epidural hematoma may vary depend on the site of hematoma.
*Findings in physical examination of patients with epidural hematoma may vary depend on the site of [[hematoma]].
*In patients with cranial epidural hematoma various focal neurologic sign may be seen depend on the site of hematoma.
*In patients with [[cranial]] epidural hematoma various [[focal neurologic signs]] may be seen depend on the site of [[hematoma]].
*Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes,
*Physical examination of patients with [[cranial]] epidural hematoma is usually remarkable for [[loss of consciousness]], unilateral [[Deep tendon reflex|diminished deep tendon reflexes]], unilateral fixed [[mydriasis]] and abnormal [[pupillary reflex]], down and out positioned eyes, loss of vision in [[contralateral]] side of [[hematoma]] and abnormal [[Vertical gaze center|vertical gaze]].
unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes and loss of vision in contralateral side of hematoma and abnormal vertical gaze.
*[[Glasgow coma scale]] in most patients with epidural hematoma is reduced.
*In patients with brain herniation due to epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen.
 
*In patients with [[brain herniation]] due to the epidural hematoma [[respiratory arrest]] and [[Cushing's triad]](hypertension, [[bradycardia]], and irregular [[respiration]]) may be seen.
*Findings in neck examination of patients with spinal epidural hematoma is usually include [[stiffness]] and [[tenderness]].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with epidural hematoma usually appear ill and confused and may have sever pain.  
*Patients with epidural hematoma usually appear ill and [[Confusion|confused]] and may have sever pain.  


===Vital Signs===
===Vital Signs===


*[[Bradycardia]] with regular pulse mat be seen.
*[[Bradycardia]] with regular pulse may be seen.
*Tachypnea and irregular respiration may be present.
*[[Tachypnea]] and irregular [[respiration]] may be present.
*High/low blood pressure with normal pulse pressure may be seen.
*High blood pressure with normal pulses pressure may be seen.


===Skin===
===Skin===
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Findings in HEENT examination of patients with epidural hematoma may include:
Findings in HEENT examination of patients with epidural hematoma may include:


* Evidence of trauma
* Evidence of [[trauma]]
* Icteric sclera
* Icteric sclera
* [[Nystagmus]]  
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
* Abnormal extra-[[ocular]] eye movements
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Non-reactive [[pupils]] to light and to [[Accommodation (eye)|accommodation]]
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Weber test]] may be abnormal
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* Tenderness upon palpation of the scalp
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Findings in neck examination of patients with spinal epidural hematoma is usually include:
OR
* [[Stiffness]]
*[[Jugular venous distension]]
* [[Tenderness]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Patients with epidural hematoma may have [[tachycardia]] or [[bradycardia]].
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with epidural hematoma is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
*In patients with spinal epidural hematoma point tenderness over the [[vertebral column]] may be present.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Genitourinary]] examination of patients with epidural hematoma is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Neuromuscular]] examination of patients with epidural hematoma may be remarkable for:
OR
**loss of orientation to persons, place, and time.
*Patient is usually oriented to persons, place, and time
** [[Altered mental status]]
* Altered mental status
** Low [[glasgow coma scale]]
* Glasgow coma scale is ___ / 15
** [[Clonus]]
* Clonus may be present
** [[Hyperreflexia]]
* Hyperreflexia / hyporeflexia / areflexia
** Unilaterally positive (abnormal) [[Babinski reflex]]
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
** Muscle rigidity
* Muscle rigidity
** Unilaterally muscle weakness
* Proximal/distal muscle weakness unilaterally/bilaterally
** [[Nystagmus]]
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
** Abnormal extra-[[ocular]] movements
*Unilateral/bilateral upper/lower extremity weakness
**Non-reactive pupils to light and to [[Accommodation (eye)|accommodation]]
*Unilateral/bilateral sensory loss in the upper/lower extremity
**Unilateral [[sensory loss]]
*Positive straight leg raise test
**[[Gait abnormality|Abnormal gait]]
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 15:30, 13 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Physical Examination

Appearance of the Patient

  • Patients with epidural hematoma usually appear ill and confused and may have sever pain.

Vital Signs

  • Bradycardia with regular pulse may be seen.
  • Tachypnea and irregular respiration may be present.
  • High blood pressure with normal pulses pressure may be seen.

Skin

HEENT

Findings in HEENT examination of patients with epidural hematoma may include:

Neck

  • Findings in neck examination of patients with spinal epidural hematoma is usually include:
  • Stiffness
  • Tenderness

Heart

Abdomen

  • Abdominal examination of patients with epidural hematoma is usually normal.

Back

  • In patients with spinal epidural hematoma point tenderness over the vertebral column may be present.

Genitourinary

  • Genitourinary examination of patients with epidural hematoma is usually normal.

Neuromuscular

References

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