Epilepsy physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Physical Examination
Physical examination of patients with epilepsy is usually remarkable for:
Appearance of the Patient
- Patients with epilepsy usually appear normal between the seizures.
- During an epileptic seizure, based on seizure type they present with signs such as:
- Automatic behaviors
- Upward eye rolling
- Unconsciousness
- Drooling
- Cyanosis
- After an epileptic seizure, based on seizure type the can present with signs such as Drowsiness and confusion or no sign at all.[1]
Vital Signs
- Fever may be present during the seizure or in the post-ictal phase.
- Tachycardia is present during the seizure and sometimes continue to be high in post-ictal phase.
- Hypertension may be present during the seizure which mostly come back to normal value few minutes after seizure.[2]
Skin
HEENT
- HEENT examination of patients with [disease name] is usually normal.
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- 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".)
- 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".)
Neck
- Neck examination of patients with epilepsy is usually normal.
Lungs
- Pulmonary examination of patients with epilepsy is usually normal but they are in increased risk of aspiration and sometimes can present with sign and symptoms of recurrent pneumonia such as:[4][5]
- Physical signs
- Respiration rate >20/min
- Percussion dullness
- Auscultation abnormality
- Bronchial breathing
- Crackles
- Temperature
Heart
- Tachycardia before, during and after seizure[6]
Abdomen
- Abdominal examination of patients with epilepsy is usually normal.
Back
- Back examination of patients with epilepsy is usually normal.
Genitourinary
- Urine and fecal incontinence may be present during a seizure attack.
Neuromuscular
- Neuromuscular examination of patients with epilepsy is usually normal.
- During a seizure attack:
Extremities
- Extremities examination of patients with epilepsy is usually normal.
References
- ↑ 1.0 1.1 Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
- ↑ Hampel KG, Jahanbekam A, Elger CE, Surges R (October 2016). "Seizure-related modulation of systemic arterial blood pressure in focal epilepsy". Epilepsia. 57 (10): 1709–1718. doi:10.1111/epi.13504. PMID 27549906.
- ↑ Hoefnagels WA, Padberg GW, Overweg J, van der Velde EA, Roos RA (February 1991). "Transient loss of consciousness: the value of the history for distinguishing seizure from syncope". J. Neurol. 238 (1): 39–43. PMID 2030371.
- ↑ Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ (May 2003). "Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection". Br J Gen Pract. 53 (490): 358–64. PMID 12830562.
- ↑ DeToledo JC, Lowe MR, Gonzalez J, Haddad H (August 2004). "Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients". Epilepsy Behav. 5 (4): 593–5. doi:10.1016/j.yebeh.2004.03.009. PMID 15256199.
- ↑ Behbahani S (July 2018). "A review of significant research on epileptic seizure detection and prediction using heart rate variability". Turk Kardiyol Dern Ars. 46 (5): 414–421. doi:10.5543/tkda.2018.64928. PMID 30024401.
- ↑ Olsen, T. S.; Hogenhaven, H.; Thage, O. (1987). "Epilepsy after stroke". Neurology. 37 (7): 1209–1209. doi:10.1212/WNL.37.7.1209. ISSN 0028-3878.