Transient ischemic attack 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
The goals of physical examination in patient with TIA may include determining the underlying neurological deficit, to assess the cardiovascular risk factors and to establish thrombotic or embolic source of TIA.[1][2][3]
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 may include the following:[1][2][3]
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
References
- ↑ 1.0 1.1 Inoue T, Kimura K, Minematsu K, Yamaguchi T, Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) (2004). "Clinical features of transient ischemic attack associated with atrial fibrillation: analysis of 1084 TIA patients". J Stroke Cerebrovasc Dis. 13 (4): 155–9. doi:10.1016/j.jstrokecerebrovasdis.2004.06.004. PMID 17903968.
- ↑ 2.0 2.1 Lewandowski CA, Rao CP, Silver B (2008). "Transient ischemic attack: definitions and clinical presentations". Ann Emerg Med. 52 (2): S7–16. doi:10.1016/j.annemergmed.2008.05.017. PMID 18655918.
- ↑ 3.0 3.1 Hatala R, Smieja M, Kane SL, Cook DJ, Meade MO, Nishikawa J (1997). "An evidence-based approach to the clinical examination". J Gen Intern Med. 12 (3): 182–7. PMC 1497085. PMID 9100144.