Transient ischemic attack physical examination

Transient ischemic attack Microchapters
Home
Main Stroke Page
Ischemic stroke Page
Hemorrhagic Stroke Page
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Transient Ischemic Attack from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
CT
MRI
Echocardiography
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
AHA/ASA Guidelines for Stroke
Future or Investigational Therapies
Case Studies
Case #1
Transient ischemic attack physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Transient ischemic attack physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Transient ischemic attack physical examination
CDC on Transient ischemic attack physical examination
Transient ischemic attack physical examination in the news
Blogs on Transient ischemic attack physical examination
Directions to Hospitals Treating Transient ischemic attack
Risk calculators and risk factors for Transient ischemic attack physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Goals of phyical examination

The goals of physical examination may include:

• To determine the underlying neurological deficit
• To assess the cardiovascular risk factors
• To establish thrombotic or embolic source of TIA

Physical examination

The sequence of physical examination in the patient suffering from transient ischemic attack is as follows:

Vital signs

Vital signs are essential component of initial physical assessment of patients with TIA:
Blood pressure

• Blood pressure assessment may help determine future risk of stroke.
• Blood pressure >140/90mm Hg adds a point to the ABCD2 score of future stroke assessment.

Pulse

• Irregularly irregular pulse may give a clue to underlying atrial fibrillation or valvular abnormality.
• Weak or feeble pulse need further cardiological assessment of patients with TIA.

Temperature

• Temperature may be normal or may increased indicating underlying infectious or inflammatory pathology.

Respiratory rate

• Abnormally increased or decreased respiratory rate may warrant underlying cardiac or pulmonary pathology.

Neurological assessment

A detailed neurological assesssment is an important component of TIA. It may give a clue to previous stroke or TIA attack and residual deficit. A standard NIHSS scale may used for neurological assessment and can help predict prognosis. Neurological assessment may be focused to neurovascular distribution at initial clinical presentation of patient. The components to be assessed include:

• Mini Mental status examination
• Cranial nerve assessment
• Somatic motor strength
• Deep tendon reflexes
• Detailed sensory examination
• Cerebellar assessment
• Speech and language testing

Systemic review

To look for underlying risk factors responsible for TIA, a complete systemic examination is essential
Heart

• Surgical scar for previous cardiac surgery
• Abnormal heart rate and rhythm may point towards atrial fibrillation, valvular disease.
• Murmurs, rub or gallop may indicate underlying cardiac or valvular abnormalities

Neck

• Surgical scars for carotid endartectomy
• Aucultation of neck may reveal carotid bruit-carotid stenosis

Lung

• Signs of cardiac failure such as bilateral fine crepitations-Pulmonary edema

Skin

• Abnormal bruising or blueness of nails or skin may suggest underlying coagulopathy

Fundoscopy

• Retinal pigmentaion, plaques or signs indicative of uncontrolled hypertension or diabetes mellitus