Ischemic stroke physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.[1]
Physical Examination
Site of Infarction | Specific area involved | Physical exam findings | |||||||
---|---|---|---|---|---|---|---|---|---|
Motor strength | Reflexes | Cranial nerves involved | Sensations | Coordination | Babinski's sign | Pupils | Pupillary reflex | ||
Cerebral cortex | Frontal lobe
Perietal lobe temporal lobe Occipital lobe |
++ | + | ++ | + | + | ++ | + | + |
Brain stem |
|
++ | ++ | ++ | + | + | ++ | + | + |
Cerebellum | Community-acquired, ingestion of undercooked poultry | ++ | + | ++ | + | + | ++ | + | + |
"Central pathway involved" |
|
± | + | ++ | ++ | + | ++ | + | + |
Glassgow coma score
Glassgow coma score helps determine the severity of infaction, extent of damage and prognosis in unconscious or semi conscious patients. [2][3][4][5][6]
Parameter | Patient response | Glassgow coma score |
---|---|---|
Eye opening |
|
|
Verbal response |
|
|
Motor response |
|
|
Appearance
The patient may appear confused.
Eye
- Vision problems may be present.
- Drooping of eyelid (ptosis) and weakness of ocular muscles
Ear
- Altered hearing may be present.
Extremities
Neurologic
- Abnormal speech
- Acute facial paresis
- Decreased reflexes: gag, swallow, pupil reactivity to light
- Disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
- Hemineglect (involvement of parietal lobe)
- Loss of co-ordination
- Memory deficits (involvement of temporal lobe)
- Numbness
- Reduction in sensory or vibratory sensation
References
- ↑ 1.0 1.1 Goldstein L, Simel D (2005). "Is this patient having a stroke?". JAMA. 293 (19): 2391–402. doi:10.1001/jama.296.16.2012 url=http://jama.ama-assn.org/cgi/content/full/296/16/2012 Check
|doi=
value (help). PMID 15900010. - ↑ Sternbach GL (2000). "The Glasgow coma scale". J Emerg Med. 19 (1): 67–71. PMID 10863122.
- ↑ Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI (2016). "The reliability of the Glasgow Coma Scale: a systematic review". Intensive Care Med. 42 (1): 3–15. doi:10.1007/s00134-015-4124-3. PMID 26564211 : 26564211 Check
|pmid=
value (help). - ↑ Gabbe BJ, Cameron PA, Finch CF (2003). "The status of the Glasgow Coma Scale". Emerg Med (Fremantle). 15 (4): 353–60. PMID 14631703.
- ↑ Tsao JW, Hemphill JC, Johnston SC, Smith WS, Bonovich DC (2005). "Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke". Arch Neurol. 62 (7): 1126–9. doi:10.1001/archneur.62.7.1126. PMID 16009770.
- ↑ Haug RH, Picard U, Matejczyk MB, Indresano AT (1989). "The infected prosthetic total temporomandibular joint replacement: report of two cases". J Oral Maxillofac Surg. 47 (11): 1210–4. PMID 2509651.